Introduction Crankshaft phenomenon is determined as a loss of three-dimensional correction of the scoliosis curve, which occurs after posterior fusion in children who have not completely finished skeletal growth. Dubousset named this phenomenon when he noticed that the entire spine and torso gradually turn and deform anterior spine, which continues to grow and rake around the axis of the fusion mass. This is mostly seen in infantile and juvenile idiopathic scoliosis, however this also occur in adolescents who are immature at the time of the last fusion. Aim To analyze this phenomenon in adolescents who have not finished skeletal growth and were operated for idiopathic scoliosis. Material and Methods This retrospective–prospective study analyzed 48 randomly selected adolescents operated for idiopathic scoliosis in Clinic for Orthopaedic and Traumatology in Tuzla between 1996 and 2011. Patients operated only with a posterior stabilization and fusion were divided into two groups. One group consisted of adolescents with intensive growth (12 years for girls and 14 years for boys) and another group consisted of adolescents at final stage of skeletal growth (14 years for girls and 16 years for boys). We measured Cobb angle at standard X-rays performed in an upright posture immediately after the surgery and at the latest X-rays done at the end of skeletal growth at the age of 18 years. Results Increasing Cobb angle was noted in 53% of studied patients. In group A higher values of Cobb angle noted in 69.56% examinees and in 36% in group B. When we analyzed both groups Cobb angle increased from preoperative 19.6 degrees to postoperative 22 degrees (2.4 degrees—12.2%) (r = 0.98), In group A preoperative Cobb angle increased from preoperative 20.6% degrees to postoperative 24 degrees (3.4 degrees—16.22%) (r = 0.97), while in group B from 18.60 to 20 degrees (1.4 degrees—7.52%) (r = 0.98). Conclusion Postoperative deformity progression of anterior column in adolescents operated for idiopathic scoliosis could be seen even if the stable fusion achieved. The risk for progression is higher in younger patients.

Abstract OBJECTIVE: Anomalies of vertebrobasilar vessels arise as early embryonal developmental deteriorations. The majority of them concern the position, origin and shape of the basilar artery. Therefore the present study was carried out to find out the variations in position and shape of the basilar artery using Magnetic Resonance Imaging and CT Angiography. MATHERIAL AND METHODS: The study included 130 consecutive patients, adults of both sexes, treated in UKC Tuzla. Patients were divided into two groups. In one group (100) were patients without aneurysm in the vertebrobasilar tree, and in the second group (30) patients with aneurysm. RESULTS: Three types of variations in the shape of basilar artery were recorded: those with arched course, S-shaped course, and the straight course type. All the three types are approximately of the same percentage prevalence in the group of subjects without aneurysm in the vertebral-basilar tree, as well as in the group with aneurysm. Basilar artery at 89.33% of respondents was located in medial or in paramedial position. CONCLUSION: Attention is drawn to the practical importance of such variations as a possible source of diagnostic errors during cerebral arteriography. We highlight the morphological aspects of the basilar artery, the knowledge of which would help neurosurgeons safely diagnose, as well as plan and execute vascular bypass and shunting procedures for the treatment of stenosis, aneurysms and arteriovenous malformations.

AIM To examine a possible relationship between the variable vascular geometry of vertebrobasilar joint angle and basilar bifurcation angle as well as the diameters of these blood vessels. METHODS The study included 60 adult patients, of both sexes, who were divided into two groups. One group (30) consisted of patients without aneurysm of vertebrobasilar tree, and another group (30) of patients with aneurysm. The patients were examined using Magnetic Resonance Imaging (MRI) and Computed Tomography Angiography (CTA) of head and neck. RESULTS In the group without aneurysm of vertebrobasilar tree, in 14 (46.6%) patients diameters of the right and the left vertebral artery were approximately the same. The average value of the angle of junctions of vertebral arteries was 65.43°, and the average angle of basilar bifurcation was around 94.53°. In the group with aneurysm of vertebrobasilar tree, in 12 (40%) patients diameters of the right and the left vertebral artery were also approximately the same. The average angle of junction of vertebral arteries was 68.46º, and the average angle of basilar bifurcation was 121.93º. CONCLUSION Anatomic variations of the vertebrobasilar joint angle and basilar bifurcation angle, as well as the diameters of these blood vessels, are some of the factors in the increase of the incidence of aneurysm in this anatomic area.

ABSTRACT Introduction: The morphological anatomy of the posterior circulation is very complex and variable. Aims of this research were to document the morphological anatomy of the posterior circulation along with variations in the Bosnian population, in patients with or without aneurysm. Measurements of the outer diameters of the vertebral artery, basilar artery and posterior cerebral artery were taken. The second aim was to determine the possible relationship between diameters of the area with subsequent aneurysm formation. Material and Methods: The study involved 60 consecutive patients, adults of both sexes, treated in the UKC Tuzla.The patients were divided into two groups. One group consisted of the patients without aneurysm of basilar artery, and the other group of patients with aneurysm. All the 60 patients were treated by means of MRI angiography. Results: The mean diameter of the vertebral artery was 2,43 mm; 3.61 mm on the right and 2,83 mm; 3,94 mm on the left. The diameter of the basilar artery varied from 3, 8 mm; 3, 43 mm. The diameter of the posterior cerebral arteries 2, 5 mm; 2,52 mm on the right and 2,46 mm; 2,62 mm on the left. Conclusions: We have documented the various morphometry variations as well as the differences of the anatomy in this area in Bosnian population as compared to the medicine literature.

Objective. To describe the intrahepatic bile duct transposition (anatomical variation occurring in intrahepatic ducts) and to determine the frequency of this variation. Material and Methods. The researches were performed randomly on 100 livers of adults, both sexes. Main research methods were anatomical macrodissection. As a criterion for determination of variations in some parts of bile tree, we used the classification of Segmentatio hepatis according to Couinaud (1957) according to Terminologia Anatomica, Thieme Stuugart: Federative Committee on Anatomical Terminology, 1988. Results. Intrahepatic transposition of bile ducts was found in two cases (2%), out of total examined cases (100): right-left transposition (right segmental bile duct, originating from the segment VIII, joins the left liver duct-ductus hepaticus sinister) and left-right intrahepatic transposition (left segmental bile duct originating from the segment IV ends in right liver duct-ductus hepaticus dexter). Conclusion. Safety and success in liver transplantation to great extent depends on knowledge of anatomy and some common embryological anomalies in bile tree. Variations in bile tree were found in 24–43% of cases, out of which 1–22% are the variations of intrahepatic bile ducts. Therefore, good knowledge on ductal anatomy enables good planning, safe performance of therapeutic and operative procedures, and decreases the risk of intraoperative and postoperative complications.

Background and Purpose: Investigations of the larynxes in thyrty infants during the first year of life of both sexes, randomized trial, were performed by morphological and histologic analysis. Morphometric parameters of the larynx as: length (anterolateral parameter), width (transverse parameter) and thickness (anteroposterior parameter) were determined. These parameters determine the size and shape of the larynx. The repciprocal relation parameters which determinate size of the larynx in infants and the body length are in high correlation. Therefore, the equation for calculating the size of the larynx out of the body heght was founded. Histologic characteristics of the laryngeal cartilage are constant. They indicate evident changes, that are the basis for approximate determination of a child’s age. Materials and Methods: The organs of the infants were taken from pathoanatomical autopsies. None had changes in the respiratory system. The major methods of the investigatio were anatomical macrodissection, morphological and histologic analysis and statistics. Results: The average body length in infants was 540 ± 20 mm (54 ± 2cm) and the average larynx length was 11.9± 0.3 mm. There was a correlation between these parameters p ‹ 0.01 (r = 0.75). The average value of the width of the larynx in infants was 17.7 ± 0.5 mm. The width of the larynx was in correlation with the body length p ‹ 0.01 (r = 0.79). The average value of the thickness of the larynx was 12.6 ± 0.4 mm. This parameter was correlated with the body length p < 0.01 (r = 0.82). Histological analyses results of our investigation, cartilage of the larynx in infants, show that hyalin structure is the result of age changes. Conclusion: Quantitative anatomical knowledge on the larynx in the pediatric population are necessary for the clinical orientation, particularly for choosing a suitable endotracheal tube. Size of the larynx in prematures, neonates and small children, constantly follows the external body dimensions, particularly the body height, that is confirmed by the correlation factor in its highest value. They indicate evident changes, that are the basis for approximate determination of a child’s age. Hyalin structure is in correlation to the children’s age.

Summary This research involved 50 patients processed in PZU, »Medicom« Zenica, by the method of MRI-angiography when performing MR of the neck. The way of ramification of the a. carotis externae, that is described in classical anatomy textbooks, where its branches separate as individual branches, is found in 76,6% to 81%, according to the data from the literature available. These data are confirmed by our researches, where presence of this ramification type was found in 84% of the total number of technically accurate MRI angiograms (91 angiogram). In 16% of cases, the branches of a. carotis externae originate as common trunks, or have unusual place of origin (a. carotis communis). A. thyroidea superior in 1,09% originates as common trunk with a. lingualis, but in three cases (3,33%) it originates as common trunk with a. lingualis.

Introduction: clinical examination and surgical procedures require the knowledge of anatomical peculiarities of a complex area such as neck, especially if the anomalies in develoment of vascular system may occur. Aim: to investigate the mutual relation of the initial parts of the internal carotid artery and the external carotid artery, as well as the height of crossing of these blood vessels. Patients and methods: we evaluated 50 patients referred to diagnostic center of the PZU „Medicom“ Zenica, by using of magnetic resonance imaging (MRI) of the neck. Results: External carotid artery is placed medially and goes to the frontal side of the internal carotid artery in 90% cases. In 7% of cases the right internal carotid artery is placed laterall from the internal carotid artery. Divergent position, where the internal carotid artery (medially) and the external carotid artery go away from each other, was found in 1% of cases. We also found that the internal carotid artery and external carotid artery cross approximately 3.04 cm above the bifurcation (at right 3.05 cm and at left 3.12 cm) and the height of the crossing varies from 1.3 cm to 4.2 cm (at right 1.3 cm to 4.2 cm, and at left 1.5 cm to 4.1 cm). The height of crossing is symmetric in 18% of cases. Reversal of the position of the external and internal carotid arteries was found in 7% cases. Conclusion: The possibility of an inversed disposition of the internal and external carotid arteries must be held in mind when performing arterial ligatures in the carotid triangle, to avoid damage to the internal carotid artery or haemorrhagic accidents.

An outstanding development of procedures and techniques of vascular, plastic and reconstructive surgery demands the competence on variable anatomy of carotid blood vessels. This paper researched the anatomy of a. thyroideae superior by MR – angiography. It was established that it originates in 87.9% of cases as a separate branch of a.carotis externae, and in 5.47% it originates from a. carotis communis, or from its bifurcation.

This describes the indivisible anastomosis of the main stem of median nerve with ulnar nerve through cubital tunnel followed by the anomaly of ulnar artery that appears as superficial ulnar artery. Both anomalies are found during the anatomical dissection of a grown-up male cadaver, on his right arm. Such case is very rare as, in the literature available to us, it has not been described.

Variations of extrahepatic bile ducts are the basis of hepatobilliar surgery, and they may be a problem during the surgical procedures. In this paper we present the results of our research, wich is conducted on 100 human livers. Common hepatic duct wich is formed by connecting of right hepatic duct and left hepatic duct is noticed in 92% of cases, and in 5% of cases was formed by tree bile ducts. Aberant bile ducts was found in 3% of total number of examined.

UNLABELLED Research has been done at a 150 pairs of the human adult kidneys (50 anatomical preparedness plus 100 patients) both sex, randomly chosen. Variations of the kidneys have been analyzed and their respect at a live ones, by clinical tree-dimensional "image"methods and lifeless one by anatomical macro dissection plus corrosive method. CONCLUSION At the most presence of noticed variation had into a size of the kidney, and the lowest one in the number of the kidneys. Technique of magnetic resonance (MR), in relation with computerized tomography (CT) had shown more types of the kidneys variations and more number of the kidney's variations in the form. Percentage of variations of the kidneys at an anatomical preparedness in relation with variations noticed by MR and CT, into a size had relation 44: 4: 0, in the form of 36: 6: 2, in the number 0: 2: 0 and into a location ( rotation) 0: 0: 4. The number and the type of noticed variations of the kidneys show the largest presence at an anatomical matiarials assigned by anatomical macro dissection and corrosive technique in relation with noticed variations of the kidneys by MR and CT. Because of that anatomy finding are set as an imperative into methodological researches of variable anatomy of the kidneys.

Having knowledge on models of the bronchial tree branching, is of a special interest for clinical and surgical pulmology, because the hemilobectomy, segmentectomy and subsegmentectomy are always determined by intralobar, intrasegmental and intrasubsegmental bronchial ramification. Investigations were performed on 100 lungs of children and adults of both sexes, one day to 85 years old, randomly chosen. There are two main types of branching of the left upper lobe bronchus: the bifurcation pattern as dominant model in 74% and the trifurcation model found in 26%. Out of 100 lungs studied, 21 lungs had the ventilatory variations of the bronchopulmonary segments. The classification and categorization of the ventilatory of bronchopulmonary segments of the left upper lobe of lung were made. This classification contains 5 categories and 8 subcategories.

The ductus cysticus is variable in the length, position and the site where it enters the ductus hepaticus communis--the cystohepatic junction. The investigations were carried out on 100 livers (50 anatomical preparations and 50 patients) adults of both sexes, randomized trial. Main methods of the research were: anatomical macrodissection and analysis of the clinical radiograms. The ductus cysticus were present as: flat--down course in 70%, flat--horizontal course in 2%, flat--ascendant course in 4%, curved in the shape "J" in 10%, curved in the shape "S" in 12% and curved in the shape "U" in 2%. The cystohepatic junction shows variations in topographic zones.

There were investigated variations of appendix vermiformis in the place of origin and position. The investigations were carried out on 50 human preparations of adults of both sexes, unintentional choice. The position and relation between intestinum caecum and appendix vermiformis were determined by forensic medical and pathoanatomical autopsy. Place of origin of appendix vermiformis, from wall of intestinum caecum is determined by anatomical dissection. Intestinum caecum has a variable shape and it occurs in two forms: conical, which dominates (56%) and square (44%). It has constant position in fossa iliaca dextra in 100% of 50 investigated cases. Appendix vermiformis is fully variable organ as for position and the place of origin from the wall of intestinum caecum. Dominantly (52%) it has rising position, and two subtypes are present: retrocecal (more expressed-38%) related to the retrocolic subtype (14%). Very frequent position of appendix vermiformis is a falling one (32%), in which pelvic position is more frequent (26%) related to descendent position (6%). Appendix vermifirmis is located subcaecaly in 8% of total number of investigated cases, found in three subtypes. It is found out that ostium appendicis vermiformis has a variable position in the wall of intestinum caecum. It is predominantly placed in the middle of the lower pole of the intestinum caecum (58%), in medial wall it is present in 32%, of all investigated, and in the lateral wall in the least number case 10%. The results of these investigations point out how important is to know variable anatomies of appendix vermiformis, for the clinical image of acute appendicitis is undoubtedly caused by the variable anatomical relations.