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Fuad Šišić

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The aim of the investigations was to demonstrate different types of collaterals of coronary arteries using the method of coronary angiography and injection-corrosion method. The investigations were carried out on 30 human cadaveric hearts from the Department of Anatomy, and 30 angiograms of patients from the Cardiology Department of Clinics Centre in Sarajevo. Clinical investigations were retrospective and prospective on patients that were treated in hospital, and on patients that just arrived in hospital (based on findings of coronary angiography). The results show the existence of different types of collaterals: intercoronary and intracoronary. We established collaterals in a case with occlusion of the right coronary artery and left coronary artery in which better development of collaterals was established. Our patients were classified in two groups: 1) Patients with good collaterals and good left ventricular function; 2) Patients with good collaterals and impaired left ventricular function. On the anatomical material we found different types of collaterals as well. Our results show that coronary angiography is useful diagnostic method for the demonstration of coronary collaterals.

A. Hasanović, A. Kulenović, F. Sisić

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.

N. Obralić, F. Gavrankapetanović, Z. Dizdarević, O. Durić, F. Sisić, I. Selak, S. Balta, B. Nakaš

Background. Due to specific war and post-war situation in Balkan region, differences in the number, type, development, biological course, treatment of malignant tumours and its outcome are possible. In order to perceive the situation realistically, it is necessary to gather continuously exact data about malignant tumours and compare them with the data from other European and world countries.The aim of the study was to collect and analyse the data on cancer incidence in the region of Sarajevo city, which represents a symbol of difficult times in the recent past, and to compare it to the incidence in the neighbouring countries. Patients and methods. Data on all newly diagnosed cancer cases, permanent residents of Sarajevo Canton, in the years 1999 and 2000 were collected. Crude incidence rate has been calculated according to the years observed, gender and localizations of the disease The data were compared to the cancer registries of Slovenia and Croatia and were observed in the light of specific local situation. Results. The crude cancer incidence of all sites but skin was the highest in both years and by both genders in Croatia. The incidence of the most common tumours (lung and breast cancer) was similar in all three countries. The differences in the incidence between both genders in the Sarajevo canton were registered in laryngeal and urinary bladder cancer, as well as in bone and cartilage sarcoma. Cervical cancer had extremely high incidence and was high up on the incidence list in the Sarajevo canton, which correlates with the data in developing countries. The incidence of other tumours in the post-war period is reaching expected numbers. Conclusions. It is difficult to identify whether the war and post-war stress, irregular and insufficient nutrition during and after the siege of the city of Sarajevo or some other factor influenced the cancer incidence among exposed population. The prevalence of smoking in the whole region is extremely high, in Bosnia and Herzegovina almost complete, which can influence not only the incidence of lung cancer but also laryngeal and urinary bladder cancer.

N. Obralić, F. Gavrankapetanović, Z. Dizdarević, O. Durić, F. Sisić, I. Selak, S. Balta, B. Nakaš

UNLABELLED Due to the specific war and post-war situation in Bosnia and Herzegovina it is possible to notice some differences in the number, type, advancement, biological course, treatment and its outcome. The actual situation which appeared in connection to depleted uranium has additionally raised questions about its influence on human health and about eventual increase in the number of malignant diseases in Bosnia and Herzegovina. In public, we often see that there are claims about enormous increase in the incidence of cancer. In order to achieve a realistic picture of actual condition and to avoid panic and ignorant attitude, correct and constant data of malignant tumors are necessary. THE AIM OF THE STUDY To collect and analyze data on population with malignant tumors in the region of Sarajevo city, which represents a symbol of difficult times in our country in the recent past. MATERIAL AND METHODS We have collected and analysed data on, population with malignant tumors which included persons with permanent residence in Sarajevo Canton during 5-year period, from 01.01.1998, until 31.12.2002. Results were compared to regional and world indicators, and were observed in the light of specific local situation. RESULTS During period of 5 years (1998-2002) 7733 new cases of malignant tumors were registered in Sarajevo Canton; 3940 among men and 3809 among women. Mostly registered tumors were: lung cancer, amelanotic skin tumors, breast cancer, colorectal cancer, cervical and uterine cancer, urinary bladder cancer, prostate cancer and cancer of larynx. CONCLUSIONS Number of all malignant tumors in the region of Sarajevo Canton correlates to those in South European countries and the one estimated by GLOBCAN 2000. High number was registered in 1998, possibly due to normalization of the health services (diagnostics and treatment of malignant tumors), which didn't exist during the war and early post-war period. After 2000, there is a gradual increase in the number of people with malignant tumors. The most common tumors are lung and breast cancer. Significant differences to estimation and data registrated in other South European counties is high number of laryngeal cancer, urinary bladder cancer, bone and cartilage sarcoma, brain tumors and malignant lymphomas among both genders. Cervical cancer is extremely high up on the list, which correlates with data in developing countries. The incidence of smoking in Bosnia and Herzegovina is extremely high, almost complete, which can influence not only the appearance of lung cancer but also laryngeal and urinary bladder cancer. It is hard to say whether the war and post-war stress, irregular and insufficient nutrition during and after the siege of the city or some other factor have influenced their appearance among exposed population and differences in the observed incidence.

The author analysed etiology, morphology, localization, symptomatology, diagnostics and surgical methods of treatment in 63 patients with 81 arterial aneurysms. Arterial aneurysms are not rare in vascular pathology. Most of them are atherosclerotic etiology (62%). Abdominal aorta is the most frequent localization (49%). Symptomatology and clinical findings depend on the localization, size and complications. Echosonography, with clinical finding, has presented the most accurate diagnostic procedure. Surgery is the method of the treatment of such patients, but the optimal method is the aneurysmectomy or resection of aneurysm with arterial reconstruction.

F. Sisić, M. Hamamdžić, J. Krnić, M. Stevančević, E. Duzic

Experiments were carried out on 25 grown-up dogs of both sex in general anesthesia. The supraduodenal part of the choledochus was excised and the reconstruction of the defect with a free venous autograft was made by an end to end anastomosis without use of a transitory or permanent prosthesis. The experimental animals were observed for 60 days, during which period they were checked clinically, biochemically and radiologically. After this period the animals were sacrificed and surgical peroperative control and sampling of material for histological study were made. Out of 25 experimental animals 18 (72%) survived a period of 60 days and 7 dogs died. On autopsy it was found that the cause of death in all animals was biliary peritonitis, but in only one case due necrosis of the graft. The values of bilirubin concentration at the end of the experiment showed almost normal level, but the values of the alkaline phosphate activity and transminase showed significant increased values. Intravenous biligraphy showed significant excretion of the contrast material, freely passing the graft, which was dilated due to stenotic changes of the distal anastomosis. After sacrificing the animals we found: the graft increased length, diameter, thickness wall and stenosis of the distal anastomosis. By histological exploration we found in the liver the signs of the biliary stasis and in the grafts substitution of its endothelium by biliary epithelium. Free venous autograft used as a substitute in the reconstruction of the bile duct which survived 60 days postoperatively, remained transient but with changes in the sense of elongation and dilatation caused by the stenosis od distal anastomosis. Histologically the grafts were entirely bridged by biliary epithelium.

F. Sisić, D. Durović, B. Marković, Z. Čampara

Authors present 13 patients with tumors of the retroperitoneal space. Primary tumors were revealed in 84.6%, malignant tumors in 92%, mesodermal source in 100%, liposarcomas in 30%, Operative treatment was undertaken in all patients, radical operation in 5 patients, radical operation with intervention on the surrounding structures in 4 patients, reduction tumor in one and biopsy in 3 patients.

In a group of 63 patients with 81 arterial aneurysms the author analysed the etiology, morphology, location, clinical diagnosis and treatment. Arterial aneurysms are not so rare phenomenon in vascularly pathology, most of them there are atherosclerotic etiology (62%), abdominal location (49%), symptomatology and clinical findings depends from location, size and complications. Ehosonography with clinical findings, especially for aneurysms of abdominal aorta, are certain diagnostic procedures. The method of the treatment of such patients is only surgical, but the optimal method is the aneurysmectomy or resection of the aneurysm with the reconstruction of the artery.

F. Sisić, A. Nakas, B. Vujovic, L. Vukotić, B. Stojanovic, M. Hamadzić, J. Krnić, M. Stevancić, E. Duzic

In seven dogs, the authors performed a resection of the supraduodenal part of the main bile duct, 15-2 cm. in length. The arising defect was bridged over with a free autovenous graft taken from the exterior jugular vein (T-T anastomosis), without using a temporary or permanent prosthesis. The animals were followed-up 60 days and the sacrificed. Three dogs perished: the first one on the third day due to intoxication, the second dog on the thirteenth day because of anastomosis' disruption and consequent biliary peritonitis, and the third one on the eighteenth day of unknown causes. In the immediate postoperative course the values of the bilirubin and alkaline phosphatase were increased while those of transaminase were not significantly altered. These values began to normalize during the third week. An intravenous biliography was made on the sixtieth day showing a normal filling of the gallbladder, with an orderly visualization of hepato-choledochus and its correct transit, but with stenosis at the distal anastomosis. Macroscopically, the graft appeared slightly enlarged in length and diameter due to the mentioned stenosis. Histologically, the graft took on an appearance similar to the main bile duct, while its endothelium was completely replaced by biliary epithelium. An answer about the viability of this autovenous graft to serve as a substituent of a normal common bile duct is to be expected with further experimental work.

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