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.

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.

The present study evaluated the impact of the angiographically documented collaterals on regional myocardial perfusion measured by 201thallium scintigraphy in patients with a chronic total occlusion. The study included 60 patients with chronic total occlusion who underwent rest-stress myocardial perfusion scintigraphy and coronary angiography. All patients had angiographic evidence of coronary collaterals. Patients were divided into two groups: group one had well-developed coronary collateral vessels (n=35) and group II had poor coronary collateral development (n=25). Patients with chronic total occlusion had severe and extensive stress-induced myocardial perfusion defects regardless of the grade of angiographic coronary collaterals. The perfusion defects in the group with good collaterals were predominantly reversible, suggesting that coronary collaterals preserved myocardial viability in the regions subtended by a total coronary occlusion. A significant correlation between good collaterals with complete protection and poor collaterals with no protection was noted. Our results demonstrate a protective effect of collaterals on myocardial perfusion during coronary occlusion. The effective angiographic collaterals may prevent resting regional wall motion abnormalities but do not appear to protect against stress-induced perfusion defect.

Aims: Evidence suggests patients from CALD backgrounds may have poorer health outcomes, due to a complex interplay of factors. We aimed to investigate inhospital outcomes for such patients admitted to our new Aged Care Rapid Investigation and Assessment (ARIA) unit. Methods: ARIA heralds a new development within our tertiary hospital, comprising a specialised multidisciplinary team casefinding older patients for admission to a rapidaccess geriatric unit. We prospectively included all such patients admitted to ARIA over a 14 month period and investigated whether CALD status was associated with hospital length of stay (LOS), ED LOS, new RACF admission, inhospital death, or 90day representation. Results: In total, 58% (107/185) patients were from CALD backgrounds, most commonly Italy (22), China (10) and Vietnam (8). Twothirds (69/107) patients were classified as nonEnglish speaking (NES; insufficient English to communicate their history). Compared to nonCALD patients, patients from CALD background were frailer (mean premorbid CSHA score 5.86 versus 5.59, P = 0.03); no differences were seen in terms of age (P = 0.35), sex (P = 0.19) or Charlson comorbidity index (P = 0.11). On multivariable analysis, adjusting for age, delirium, dementia and RACF residence, those from CALD background had a longer ED LOS (adjusted regression coefficient 2.59, P = 0.048; 9 versus 7 hours). CALD background was not associated with other markers of poor outcome. NES status alone was not associated with outcomes assessed. Conclusions: In this cohort of older inpatients, CALD status was not associated with poorer outcomes. Further research might focus on patient and provider factors influencing possible improvements in care and outcomes for these patients. POSTER PRESENTATIONS

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.

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.