Abstract Guidewire loss is a rare complication of central venous catheterization. A 65-year-old male was hospitalized in a high-dependency unit for exacerbation of chronic obstructive pulmonary disease, pneumonia, erythrocytosis, and clinical signs of heart failure. Upon admission, after an unsuccessful right jugular approach, a left jugular central venous catheter was placed. The next day, chest radiography revealed the catheter located in the left parasternal region, with suspected retention of the guidewire, visually confirmed by the presence of its proximal end inside the catheter. The left parasternal location of the catheter and the typical projection of the guidewire in the coronary sinus, later confirmed by echocardiography, raised suspicion of a persistent left superior vena cava (PLSVC). Agitated saline injected into the left antecubital vein confirmed bubble entry from the coronary sinus into the right atrium. After clamping the guidewire, the catheter was carefully retrieved along with the guidewire without any complications. This is the first reported case of guidewire retention in PLSVC and coronary sinus. It underscores the potential causes of guidewire loss and advocates preventive measures to avoid this potentially fatal complication.

Background: The aim of this paper was to investigate the dynamics of inflammatory parameters in patients after infrarenal abdominal aneurysm surgery.Methods: The retrospective study included patients with operated infrarenalabdominal aneurysm, divided into two groups. First group were patients that underwent endovascular aneurysm repair procedure (EVAR), and second group were patients that had open surgery. General data and inflammatory parameters (CRP, leukocytes, platelets, and fibrinogen) had been taken during hospitalization, compared mutually and analyzed.Main findings:All inflammatory parameters, observed preoperatively, were close to referent range. Serum CRP values in EVAR patients raised after operation, but returned to the reference range more quickly as well as leukocyte count. Around the middle of their own hospital stay and at the day of discharge, the group operated on by the open method had statistically significant higher platelet values than the EVAR group. During the preoperative period and in the middle of hospitalization, the group operated on by the open method shows higher fibrinogen values, while the opposite is at the day of discharge, where the EVAR group shows statistically significantly higher fibrinogen values.Principal conclusions: Observed serum inflammatory parameters (CRP, leukocytes, fibrinogen, and platelets) in different phases of hospitalization were lower; closer to the reference value in patients with infrarenal abdominal aneurysm that underwent EVAR, compared to patients operated by the open surgery method. Also, the observed parameters, except fibrinogen, returned to the reference value faster in patients who underwent EVAR.Key words: abdominal aortic aneurysm, endovascular aneurysm repair, inflammatory parameters

Aim To determine radiologic, clinic and laboratory characteristics of COVID-19 positive patients with acute arterial occlusion and compare them with post COVID-19 and non-COVID-19 patients. Methods In this retrospective study, 53 patients with acute occlusion of peripheral arteries admitted to the University Clinical Hospital Mostar in the period between 29 February 2020 and 30 September 2021 were involved. The first group was made of COVID-19 positive patients, the second group were post COVID-19 patients and a control group were non-COVID-19 patients. Results Most patients were males, 37 (69.8%). The average age of COVID positive patients was 66.09±11.25 years, post COVID-19 patients 71.33±5.22 years and COVID-19 negative patients 69.82±1.99 years. Lower extremities were most affected, 38 (71.6%), without significant alteration in the coagulogram. Acute arterial occlusion occurred about 2 weeks after the beginning of COVID-19 or at the time of the first appearance of symptoms. Conclusion We have to take special care about patients with risk factors for developing acute arterial occlusion due to thromboembolism or thrombosis 10 days after the beginning of the disease. We also recommend the use of low molecular weight heparin (LMWH) and monitoring coagulation state due to anti Xa and thromboelastometry.

Contrast-induced encephalopathy (CIE) is a rare complication of contrast media use during angiographic procedures. With the growing use of endovascular interventions, this complication is likely to become more common. We present a case of a 46-year-old woman with hypertension, hypothyroidism, and chronic renal failure. She developed CIE following cerebral angiography for diagnosis of intracranial aneurysm. We had a high index of suspicion for CIE, excluded the most common differential such as stroke, and immediately started hemodialysis with a short course of corticosteroids. The disease runs a benign course, and neurological symptoms resolved completely after five days. We emphasize the need for increased awareness of CIE to make a valid diagnosis and to start supportive therapy as soon as possible.

OBJECTIVE The aim of this study was to document the prevalence of degenerative intervertebral disc changes in the patients who previously reported symptoms of neck pain and to determine the influence of education level on degenerative intervertebral disc changes and subsequent chronic neck pain. METHODS One hundred and twelve patients were randomly selected from the University Hospital in Mostar, Bosna and Herzegovina, (aged 48.5±12.7 years) and submitted to magnetic resonance imaging (MRI) of the cervical spine. MRI of 3.0 T (Siemens, Skyrim, Erlangen, Germany) was used to obtain cervical spine images. Patients were separated into two groups based on their education level: low education level (LLE) and high education level (HLE). Pfirrmann classification was used to document intervertebral disc degeneration, while self-reported chronic neck pain was evaluated using the previously validated Oswestry questionnaire. RESULTS The entire logistic regression model containing all predictors was statistically significant, (χ2(3)=12.2, p=0.02), and was able to distinguish between respondents who had chronic neck pain and vice versa. The model explained between 10.0% (Cox-Snell R2) and 13.8% (Nagelkerke R2) of common variance with Pfirrmann classification, and it had the strength to discriminate and correctly classify 69.6% of patients. The probability of a patient being classified in the high or low group of degenerative disc changes according to the Pfirrmann scale was associated with the education level (Wald test: 5.5, p=0.02). Based on the Pfirrmann assessment scale, the HLE group was significantly different from the LLE group in the degree of degenerative changes of the cervical intervertebral discs (U=1,077.5, p=0.001). CONCLUSION A moderate level of intervertebral disc degenerative changes (grade II and III) was equally matched among all patients, while the overall results suggest a higher level of education as a risk factor leading to cervical disc degenerative changes, regardless of age differences among respondents.

A CASE REPORT OF A LONG TIME UNRECOGNIZED HYPOCHONDRIAC PATIENT WONDERING THROUGH THE HOSPITAL DEPARTMENTS Vedran Markotić, Miro Miljko, Dorijan Radančević, Maki Grle, Ines Perić, Antonela Krasić Arapović & Gojko Bogdan Department of Clinical Radiology, University Clinical Hospital, Mostar, Bosnia and Herzegovina School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina Clinic for orthopedics, University Clinical Hospital Mostar, Bosnia and Herzegovina

Men and women equally experienced a similar degree of chronic pain. Analysis of the results show that there is no significant difference in the level of chronic neck pain due to the age of the respondents. Regarding the impact of body mass index on the degree of chronic pain, the resulting analysis showed that the differences between patients with normal and excessive degree index in chronic pain are not statistically significant. Expression of chronic neck pain were equally represented among smokers and non-smokers. None of respondents practiced exercise activities including weightlifting. There was not large enough number of respondents to statisstically compare differences among groups in domain of education level. Anyway, researches should be continued.