Aim: The development of bipedal position anatomically changed the entire skeleton, not only the legs and pelvis, but also the spine, feet and skull.By studying changes in the appearance of the skull and its volume we can monitor changes of brain volume and intelligence development and human evolution. Materials and methods: The research was conducted on a specimen of 196 macerated and degreased skulls, 82 of which belong to the osteological collection of the Department of Archeology – Chair of Prehistory, Antique Period and Middle Ages – of the State Museum of Bosnia and Herzegovina in Sarajevo. From the osteological collection of the department of Anatomy of the Medical Faculty in Sarajevo, a total of 114 skulls have been examined, 57 of which were skulls of male gender and 57 of female gender. On each of the examined skulls applying craniometrical method we estimated cranial capacity. Results : Regardless of the period in question, we have the highest variability in the category cranial capacity. It is actually a natural sequence due to the impact of all three linear dimensions (length, width and height) of the skull at its formation. Conclusions: Cranial capacity shows a growing tendency going to younger period of time from which the skull encouraged, except for a slight decline during the Middle Ages. Keywords: skull, cranial capacity, craniometry, prehistoric skull, antic period skull, middle ages skull, recent period skull

Aim: The development of bipedal position anatomically changed the entire skeleton, not only the legs and pelvis, but also the spine, feet and skull.By studying changes in the appearance of the skull and its volume we can monitor changes of brain volume and intelligence development and human evolution. Materials and methods: The research was conducted on a specimen of 196 macerated and degreased skulls, 82 of which belong to the osteological collection of the Department of Archeology – Chair of Prehistory, Antique Period and Middle Ages – of the State Museum of Bosnia and Herzegovina in Sarajevo. From the osteological collection of the department of Anatomy of the Medical Faculty in Sarajevo, a total of 114 skulls have been examined, 57 of which were skulls of male gender and 57 of female gender. On each of the examined skulls applying craniometrical method we estimated cranial capacity. Results : Regardless of the period in question, we have the highest variability in the category cranial capacity. It is actually a natural sequence due to the impact of all three linear dimensions (length, width and height) of the skull at its formation. Conclusions: Cranial capacity shows a growing tendency going to younger period of time from which the skull encouraged, except for a slight decline during the Middle Ages. Keywords:  skull, cranial capacity, craniometry, prehistoric skull, antic period skull, middle ages skull, recent period skull

OBJECTIVE To provide anatomical information on the position, morphological variations and incidence of mental foramen (MF) and accessory mental foramen (AMF) as they are important for dental surgeons, anesthetists in nerve block and surgical procedures, to avoid injury to the neurovascular bundle in the mental foramen area. METHODS Our study was conducted on 150 adult dry human mandibles from the osteological collection of the Department of Anatomy of the Faculty of Medicine, University of Sarajevo. The location and shape of the MF and the presence of the AMF were studied by visual examination. The size and position of the MF were measured using a digital vernier caliper. SPSS, version 17 software was used for the statistical analysis. RESULTS Bilateral mental foramina were presented in all 150 mandibles. In the majority of mandibles, the MF was located between the first and second premolar (20.3%) or on the level of the root of the second premolar (60.3%), midway between the inferior margin and the alveolar margin of the mandible. Most of the mental foramina were oval in shape (83.3%). An AMF was present in four mandibles (2.7%) on the right side. CONCLUSION This study may be a very useful new supplement to data on variations in the incidence, position, shape and size of mental and accessory mental foramina, which may help surgeons, anaesthetists, neurosurgeons and dentists in carrying out surgical procedures successfully.

Introduction: This study evaluated the frequency of domination of the coronary arteries types in patients treated by surgical myocardial revascularization. The aim of the study was to determine whether the left coronary circulation dominance is a prognostic factor for poorer outcome in patients undergoing coronary artery bypass surgery. Material and methods: A total sample consisted of 100 patients with coronary artery disease that were treated with coronary artery bypass grafting at the Clinic for Cardiac Surgery, Clinical Center of the University of Sarajevo. To all patients on the basis of preoperative coronary angiography was determined the dominance of the coronary arteries. Patients included in the study were divided into two groups, with the left and right with coronary dominance. Results: Left coronary dominance in a sample of patients was present in 21/100 (21%), right in 69/100 (69%) and balanced in 10/100 (10%) cases. Female gender was significantly more frequent in patients with left coronary dominance and proved to be a stronger predictor of poorer outcome, especially in combination with left main stenosis of the left coronary artery and left coronary dominance. Inability of revascularization of the r. interventricularis posterior (RIVP) was statistically significantly higher in case of left dominance 9/21 (42.9%), compared to the right 16/79 (20.3%), p=0.033. Lethal outcome was more common in case of left dominance in relation to the right (9.4% vs 0.9%). The incidence of surgical complications, respiratory, neurological and renal complications was not significantly different between groups, while the length of hospital stay was significantly higher in the group of patients with left dominance, p = 0.003. Conclusion: Left coronary dominance is an important risk factor for patients undergoing surgical myocardial revascularization.

ABSTRACT Objectives: The present study evaluates our experience with aorto-coronary bypass grafting in patients with severe dysfunction of left ventricle (LV) and low ejection fraction-EF(<35%). Revascularization of myocardium in this settings remains contraversial because of concerns over morbidity, mortality and quality of life. Material and Methodes: Forty patients with severe coronary artery disease and dysfunction of LV (low ejection fraction <35%) underwent coronary artery bypass grafting in period of 3 years. Preoperative diagnostic of 40 patients was consisted of anamnesis, clinical exam, non-invasive methods EHO, MR and invasive diagnostic methods-cateterization. The major indication for surgery was severe anginal pain, heart failure symptoms and low ejection fraction. Internal mammary artery was used in all operated patients. Results: Average age of patients who have been operated was 59,8. In the present study, 81,3% were male and 18,8% female. We found one-vessel disease present in 2,5% (1/40) of patients, two -vessel disease in 40% (16/40), three-vessel disease in 42,5% (17/40) and four -vessel disease in 15% (6/40) of patients. One bypass grafting we implanted in 2,5% patients, two bypasses in 42,5%, three bypasses in 45 5%, and four bypasses in 10% of patients. Left ventricular ejection fraction assessed preoperativly was 18%-27% and postoperatively was improved to 31, 08% in period of 30 days. Conclusion: In patients with left ventricular dysfunction, coronary artery bypass grafting can be performed safely with improvement in quality of life and in left ventricular ejection fraction.

AIM To determine association between tuberculosis (TB) related stigma and delay in seeking a treatment after the onset of symptoms associated with tuberculosis. METHODS This prospective study was carried out in the "Podhrastovi" University Clinic of Lung Diseases and Tuberculosis and Health facilities for lung diseases and tuberculosis in the Sarajevo area. The sample consisted of 300 tuberculosis patients. Between patients who consider TB a stigmatizing disease and patients who did not consider TB a stigmatizing disease distribution of patient delay was compared. RESULTS Of the total of 300 patients 79 (26.3%) considered TB a socially stigmatizing disease. Among them 43 (54.4%) were females and 36 (45.6%) males. Among patients in the age group 18-24 years, nine (50%) considered TB a socially stigmatizing disease compared to seven (12.3%) among patients in the age group 65-75 years. Among patients with university degree, nine (64.3%) and among patients that had no education, one (9.1%) declared TB as a socially stigmatizing disease. The average time interval from the appearance of first symptoms of tuberculosis until the first visit to a health care facility for those who consider TB a stigmatizing disease was 6.41 weeks and for those who did not consider it a stigmatizing disease the average time interval was 4.99 weeks. CONCLUSION Study results revealed high stigma-generating attitudes towards tuberculosis. Perceived TB related stigma had no strong impact on patient delay in seeking care for TB symptoms.

Summary This paper describes the utility of flexible bronchoscopy in a sick child diagnosed with dermatomyositis, celiac disease. Mucus plug is a common medical cause of lung atelectasis. Due to deteriorated respiratory condition, the child was highly febrile, cyanotic, liver 6-7 cm, palpable under the right rib arch. We described a child with dermatomyositis and lung atelectasis. Atelectasis causes difficulty breathing and decreased oxygen saturation, so the child was intubated and put on a complete mechanical ventilation. Before intubation, the number of respirations exceeded 40/min, O2 saturation on the pulse oximeter fell under 73%. Pulse rate was 173/min, blood pressure 94/37 mmHg. Before intubation, the gas analysis of blood showed: Ph below 7.30 and pCO2 9 kPa, pO2 in the blood below 4.9 kPa. After flexible bronchoscopy was performed, therapeutic and diagnostic, lung re-expansion was enabled. After performed bronchoalveolar lavage with 0.9% NaCL 1 ml per kg TT, twice repeated, corticosteroids were introduced at the site of the changed mucus membrane. Mechanical ventilation parameters: Fio2, number of respirations and inspiratory pressure decreased. Values of gas analysis: ph improvement above 7.30 Pco2 3.6kPa, pO2 in the blood 11. O2 saturation 95%, pulse rate 120/min. The five-year-old child patient was extubated five days after bronchoscopy and was transferred to the standard Pulmonology Ward. Blood derivatives were obtained on several occasions. The condition improved, methotrexat therapy was introduced, with corticosteroids once a week, 3x40 mg i.v., on other week days Pronison 5 mg 4x1. Sažetak Ovaj rad ukazuje na značaj fleksibilne bronhoskopije kod obolelog deteta sa dijagnozom dermatomyositis, coeliakia. Sluzni čep u bronhu je čest medicinski uzrok atelektaze kod ovih bolesnika. Usled pogoršanog respiratornog stanja, obolela deca mogu imati visoku temperaturu, cijanozu, uvećanu jetru do 6- 7 cm. Prikazujemo dete sa dermatomiozitisom, koje je imalo atelektazu pluća. Atelektaza pluća uzrokuje otežano disanje, smanjenje saturacije, zbog čega je obolelo dete intubirano i priključeno na totalnu mehaničku ventilaciju. Broj respiracija pre intubacije prelazio je 40 min, saturacija oksigena saturacija na oksimetru pulsa pada ispod 73%. Puls 173/min, krvni pritisak 94/37 mmHg. Pre intubacije vrednosti plinova u krvi - pH obično su ispod 7,30 i pCO2 9 kPa, pO2 u krvi ispod 4,9 kPa. Posle izvedene fleksibilne bronhoskopije, dijagnostičke i terapijske sa bronhoalveolarnom lavažom, nastupa reekspanzija pluća. Posle izvedene bronhoalveolarne lavaže sa 0,9% NaCL 1 ml/kg TT, dva puta ponovljene, uvedeni su kortikosteroidi na mestu promene na sluznici obolelog bronha. Parametri mehaničke ventilacije: FiO2, smanjen broj respiracija i vrednosti inspiratornog pritiska. Vrednosti pH arterijske krvi se popravljaju iznad 7,30 Pco2 3,6 kPa, pO2 u krvi 11. Saturacija kiseonikom 95%, puls 120/min. Petogodišnja devojčica je pet dana kasnije ekstubirana i premeštena na standardno odeljenje pulmologije. Krvni derivati su uključeni u nekoliko navrata. Stanje se poboljšalo, tako da je methotreksat uveden u terapiju, sa kortikosteroidima jednom sedmično, 3x40 mg i.v., a drugim danima u sedmici Pronison 5 mg 4x1.

Lymphocyte Subsets in Bronchoalveolar Lavage Fluid of Children with Lung Infiltrates The analysis of the subpopulation of lymphocytes - CD4+, CD8+ lymphocytes in bronchoalveolar lavage (BAL) of paediatric patients can provide useful information related the lung parenchyma. The aim of the paper was to analyze the results of bronchoscopy of patients presenting with persistent lung infiltrates and to find out of the diagnostic yield and complication rate of this procedure. The study is a retrospective one. The data related to paediatric findings and BAL results of the bronchoscopies were retrieved from the hospital records. BAL was performed in tracheobronchial airways (middle lobe) by bronchoscope and sent to analysis of CD4+, CD8+ lymphocytes. Bronchoscopy was performed under general anesthesia (sedation, propofol, midazolam, morphium). The records of seven patients were analyzed. All patients presented with persistent lung infiltrate (atelectasis and pneumonia). 71% of the patients with lung infiltrates in our study were below the age of 5. Our study results showed that CD4+, CD8+ lymphocytes in BAL in the studied group showed a small percentage of CD8+ lymphocytes as an immune response in 8-10% of patients, while the cellular response of CD4 +lymphocytes in the sample itself was present up to 14% in the entire group of the diseased children. There was no serious desaturation during bronchoscopy. Bronchoscopy with BAL findings of lymphocyte populations is important in the early identification of inflammation and it helps in therapeutic strategies and monitoring of inflammatory response to the given therapy. Subpopulacija limfocita u bronhoalveolarnoj lavaži kod pedijatrijskih bolesnika sa plućnim infiltratom Analiza subpopulacija limfocita u bronhoalveolarnoj lavaži (BAL) kod pedijatrijskih bolesnika može nam pružiti korisne informacije o dešavanju u parenhimu pluća. Cilj rada bio je analiza rezultata bronhoskopije i BAL-a kod bolesnika sa perzistentnim plućnim infiltratima i stope komplikacija kod ove procedure. Ovo je retrospektivna studija. Podaci o pedijatrijskim nalazima i rezultatima BAL bronhoskopija uzeti su iz bolničke evidencije. BAL je izvršena bronhoskopom unutar traheobronhalnog stabla (srednji lobus) i upućena na CD4+, CD8+ limfocita. Za vreme bronhoskopije nije zabeležena ozbiljnija desaturacija. Bronhoskopija je urađena u opštoj anesteziji (propofol, midazolam, morfijum). Analizirano je ukupno 17 istorija bolesti. Svi bolesnici imali su perzistentne plućne infiltrate (atelektazu i upalu pluća). 71% bolesnika sa plućnim infiltratima bili su mlađi od 5 god. Rezultati naše studije pokazali su da CD4+, CD8+ limfociti u BAL-u na datoj grupi pokazuju mali procenat CD8+ limfocita kao imunu reakciju kod 8-10% bolesnika, dok je ćelijska reakcija CD4+ limfocita u samom uzorku bila zabeležena kod 5%, odnosno 14% bolesnika u čitavoj grupi obolele dece. Bronhoskopija sa BAL-om je značajna metoda u identifikaciji imunog odgovora u plućima i primeni adekvatne terapije.