Syringocystadenoma papilliferum is a benign cutaneous adnexal tumor of eccrine and apocrine glands, with a warty appearance that is usually found on the scalp, neck and face, much less frequently appears in the chest or abdomen and extremely rarely on the female genital organs, i.e. the vulva. We present a case of Syringocystadenoma papilliferum on the vulva of a 64-year-old woman. This case illustrates the atypical location of this rare disease and adds to the differential diagnosis of lesions on the vulva.

In clinical practice, there is a very common discrepancy between the clinical findings of patients with lumboischialgia and the radiological findings. This research aimed to determine the degree of correlation between the ODI index and the VAS scale with degenerative changes in the lumbar spine found using MRI. The study included 100 patients, who were referred for an MRI of the lumbar spine and who had a clear clinical picture of lumboischialgia. Patients underwent MRI. Degenerative changes in the lumbar spine and discs were analysed. Patients were asked to answer the questions in the questionnaire about the subjective feeling of pain and functional status, and ODI and VAS scores were calculated. There has been a statistically significant correlation found between the answers to the survey questions and the VAS score (p < 0.001). There was a significant correlation obtained between the level of degeneration and the disability index (p = 0.022), while the correlation with the VAS score has not been found to be significant (p = 0.325). This study has demonstrated a significant correlation between the VAS pain score and the ODI, as well as a significant correlation between the level of degeneration on MRI scans and the disability index; however, the correlation of MRI scan results with VAS score has not been found to be significant.

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Background: Conflicting data exist on traditional lipid profiles in patients with Alzheimer’s disease (AD) and vascular dementia (VD), whereas scarce number of studies evaluated non-traditional lipid profiles in patients with AD and VD. Studies have shown that ethnic background may affect lipid profile. Objective: The aim of the present study was to conduct comparative assessment of traditional and non-traditional lipid profiles in Bosnian patients with AD and VD. Methods: A controlled, cross-sectional study was performed with 66 patients with AD, 50 patients with VD, and 60 control subjects. The Montreal Cognitive Assessment (MoCA) test was used for an evaluation of the global cognitive function. The Hachinski ischemic score was used to distinguish patients with VD from those with AD. Plasma total cholesterol (TC), high-density lipoprotein -cholesterol (HDL-C), and triglycerides (TG) levels were determined using standard enzymatic colorimetric techniques, whereas the Friedewald formula was used to calculate low-density lipoprotein-cholesterol (LDL-C) levels. The non-traditional lipid indices such as TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C ratio were separately calculated. The differences between the groups were analyzed with ANOVA followed by the Tuckey posthoc test or with the Kruskal Wallis test followed by the Mann-Whitney test. Results: Results of the present study have shown that patients in AD group had significantly lower level of TC, TG, LDL-C, VLDL-C, Non-HDL-C and significantly lower atherogenic index compared to the control group (CG) and compared to the VD patients. Significant difference in values of TG and VLDL-C was observed between VD and the CG, whereas no significant difference in values of TC, LDL-C, atherogenic index and Non-HDL-C was observed between these two groups. Our results have also shown that TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C ratios were significantly lower in AD patients compared to the VD and CG. Moreover, TG/HDL-C ratio was significantly lower in VD compared to the CG. However, a significant difference in TC/HDL-C and LDL-C/HDL-C was not observed between VD and the CG. Conclusion: Based on the results of the present study it can be deduced that there is a difference in traditional and non-traditional lipid profiles between AD and VD patients of Bosnian descent. Obtained results suggest that lipids are decreased in AD and in VD to a certain extent. However, since there is an inconsistence in literature whether there is an association between cholesterol and cognition, large prospective studies are required to elucidate this controversy.

Background: Lipids and lipoproteins are significantly involved in maintaining structural and functional components of the human brain and neurons, but their role in the development of Alzheimer’s disease (AD) and vascular dementia (VD) remains unclear. Objective: The aim of the present study was to explore the differences in the standard and novel lipid profile parameters in patients with AD and VD, stratified by the degree of cognitive impairment (CI). Methods: Present study included 66 patients with AD, 50 patients with VD, and 60 control subjects. For an evaluation of the global cognitive function the Montreal Cognitive Assessment (MoCA) test was used. In order to distinguish patients with VD from those with AD the Hachinski ischemic score was used. Plasma total cholesterol (TC), high-density lipoprotein -cholesterol (HDL-C), and triglycerides (TG) levels were determined using standard enzymatic colorimetric techniques, whereas the Friedewald formula was used to calculate low-density lipoprotein-cholesterol (LDL-C) levels. The non-traditional lipid indices such as TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C ratio were separately calculated. The differences between the groups were analyzed with the Kruskal Wallis test followed by the Mann-Whitney test or with ANOVA followed by the Tuckey posthoc test. Results: Results of the conducted study have found that the patients in AD group with moderate CI and patients in AD group with severe CI exhibited significantly lower levels of serum TC, TG, LDL-C, VLDL-C, Non- HDL-C, atherogenic index, TG/HDL-C, TC/HDL-C and LDL-C/HDL-C compared to cognitively normal control subjects. Moreover, patients in VD group with severe and moderate CI had significantly lower level of TG compared to control group of subjects. Our results have also shown that patients in AD group with moderate CI had significantly lower level of TC, TG, LDL-C, Non-HDL-C, atherogenic index, TG/HDL-C, TC/HDL-C compared to VD patients with moderate CI. In addition, patients in AD group with severe CI had significantly lower level of TC, LDL-C, Non-HDL-C and TC/HDL-C compared to VD patients with severe CI. Conclusion: The results of this study have shown dysregulation of lipid metabolism in AD and VD patients with different degree of CI. In both moderate and in severe CI, patients with AD had lower levels of majority of standard and novel lipid parameters compared to patients with VD. Further larger prospective studies are required to elucidate the accuracy of standard and novel lipid parameters in the assessment of different degree of CI in AD and VD.

Aims: Nutrient artery is the principal source of nutrition to the long bones. The topography of nutrient foramina on long bones is well known, but it has not yet been established whether the number of nutritive foramina (NF) is related to total bone length. The objective of the present study was to study the correlation of total number of nutrient foramina and long bone length of upper and lower limb to provide detailed data on such features. Study Design: A cross-sectional, descriptive study Place and Duration of Study: Department of anatomy, Medical Faculty University of Sarajevo. Study duration was 3 months. Methodology: In the present study, 300 adult human long bones of the upper (50 humeri, 50 radii, 50 ulnae) and lower (50 femora, 50 tibiae, 50 fibulae) limbs were investigated to determine the number of their nutrient foramina. The nutrient foramina were identified analysed macroscopically and total number of nutrient foramina for each bone was recorded. Total length of each bone within a group was recorded. Statistical analysis was performed to determine correlation between total bone length and number of nutrient foramina, by using SPSS version 17.0 for Windows. Results: A statistically significant negative correlations between the left humerus length and the number of NF was found. A positive correlations between the length of the right radius and the number of NF, the left ulna length and the number of NF, the right ulna length and the number of NF were found. A negative correlations between the length of the left radius and the number of NF and between right humerus length and number of NF were found. A positive correlation between the length of the right and left femur and the number of NF were found. A negative correlation between the length of left tibia and the number of NF was found, as well as negative correlation between the length of right and left fibula and number of NF. Conclusion: Total bone length is not related to the number of nutrient foramina. The number of nutrient foramina does not depend on the total length of the bone, which is important when assessing the success of grafts for transplantation on long bones in taller people.

BACKGROUND Piriform aperture is anterior opening of the nasal cavity formed by bones of the viscerocranium and knowledge about differences between genders is important for forensic scientists, anthropologists, orthopedists, neurosurgeons and vascular surgeons. The aim of this study was to examine gender differences of piriform aperture on 3D models of human skulls originating from Bosnian population using the geometric morphometric method. MATERIALS AND METHODS The study was conducted on 211 3D models of human skulls of known gender. 3D models were obtained by laser scanning. We analyzed the gender differences of piriform aperture using geometric morphometrics method. On 3D models we marked four landmarks on piriform aperture in the Landmark editor program, after which we analyzed its gender differences in MorphoJ program. RESULTS The first PCA axis described 40.398% of total variability of piriform aperture. The greatest gender variability was present in the position of the landmark rhinion. Discriminant functional analysis of the shape and size of the piriform aperture allowed the gender determination with 64.03% accuracy for male and 70.83% accuracy for female gender. The size of the piriform aperture showed a statistically significant difference between genders. Discriminant functional analysis of the shape of the piriform aperture without affecting size enabled gender determination with 59.71% accuracy for male and 62.5% accuracy for female. CONCLUSIONS Analysis showed statistically significant differences in the shape and size of piriform aperture between genders. The accuracy for gender determination based on piriform aperture was higher in females.

Abstract Introduction. Present study was performed to verify red blood cell distribution width-to-platelet ratio (RPR) level in rheumatoid arthritis (RA) patients and to examine its correlation with clinical and biochemical indicators of disease activity status. Methods. In this cross-sectional analytical study, 67 patients with RA and 34 age- and gender-matched healthy control subjects were enrolled. Based on the disease activity score 28-ESR (DAS28-ESR), RA patients were divided into subgroups: low disease activity (n = 20), moderate disease activity (n = 22) and high disease activity (n = 25). Laboratory tests included erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) concentration, platelet count (PLT), red blood cells count (RBC), red blood cells distribution width (RDW) and fibrinogen concentration. Statistical analyses were carried out using SPSS 13 software. Statistical significance was set at a p-value less than 0.05. Results. There was statistically significant difference (p = 0.006) between RPR in RA patients with different stages of disease activity, with higher values in patients with low disease activity. The RPR showed statistically significant negative correlations with ESR (rho = –0.309; p = 0.012), CRP (rho = –0.421; p = 0.001), swollen joint count – SJC (rho = –0.368; p = 0.002) and tender joint count – TJC (rho = –0.355; p = 0.003), DAS28-ESR (rho = –0.409; p = 0.001), DAS28-CRP (rho = –0.422; p < 0.0005) and Visual analogue scale – VAS (rho = –0.260; p = 0.033) in RA patients. Conclusion. The present study provided evidence that the lower RPR values in RA patients are significantly associated with the disease activity indicators.

Introduction: Intervertebral disc (IVD) degeneration (IDD) is one of the main causes of low back pain (LBP). Standardized diagnostic algorithms for adequate estimation and classification of changes of lumbar discs are mandatory before starting with therapy.Methods: One hundred patients who were indicated for lumbar magnetic resonance imaging (MRI) were included in the study. Pfirrmann grading system was used for the determination of IDD, while the visual analog scale (VAS) is used for evaluation of the intensity of LBP. To quantification of disability for LBP, we used the Oswestry Disability Index (ODI).Result: Results showed higher Pfirrmann grades II and III for L2/L3 and L3/L4 lumbar levels and lower scores at L4/L5 and L5/S1. The analysis also showed low scores at the L2/3 and L3/4 lumbar level for Pfirrmann grades IV and V, and there was an increased at more inferior lumbosacral levels L4/5 and L5/S1. There was a significant correlation between Pfirrmann grades and ODI (p = 0.24) as well as VAS (p = 0.16).Conclusion: Higher Pfirrmann grades correlated with increased ODI and VAS. Therefore, MRI can be used as a strong indicator of clinical appearance, but it is important to take into consideration that LBP should be correlated with clinical features. By summing Pfirrmann grades of all lumbar intervertebral levels in each patient, we can get more accurate insight for the status of the lumbar spine.

Aim To determine the degree of accuracy in determining the sex of the skull based on classical morphometric analysis of the mastoid process. Morphometric analysis excluded a subjective approach expressed in osteoscopic analysis. Methods The study was conducted on a sample of 100 macerated skulls of known gender and age from the second half of the 20th century, including the Bosnian population. Of the 100 skulls, 50 (50%) were male and 50 (50%) were female. Male skulls were on average 60 (47-71) years old and female 57 (43-76) years old. At each mastoid process, 3 measurements were made: mastoid length, mastoid width (medio-lateral diameter) ML) and anteroposterior diameter (AP) of the mastoid process. Results Using the univariate method, we found a significant difference between length, width, AP diameter and size of mastoid processes as well as between gender (p <0.05). Multivariate binary logistic regression showed statistically significant differences in AP diameter of the mastoid process (p<0.05). Conclusion The created model "P" ("P"=exp [X]/1+exp [X]) for sex determination based on mastoid process showed sensitivity of 82% correct prediction for female skulls and 65% accurate prediction for male skulls. This discourse with respect of population standards grants most effective anthropological proof and as such may be suggested for forensic expertise based on human skull.

Background: The femur is supplied princially by the diaphyseal nutrient artery which enters the bone throught the nutrient foramen. This supply is essential during the growing period, the early phases of ossification, and in different surgical procedures. The aim of present study was to examine the morphology and topography of the femur nutrient foramen to provide detalied data on such features.Methods: This was a cross-sectional-descriptive study in which we observed 50 femurs. We analysed the number and location of nutrient foramina, the length of the bone, the position of the nutrient foramen regarding to values of FI, correlation between number of nutrient foramen and length of femur, correlation between position of nutrient foramen and side of extremity to which femur belongs.Results: The double foramina were common in right (57.1%) and left (42.1%) femur, mostly located in medial lip of aspera line in right (64.3%) and on the lateral lip in left femur (68.4%), with statistically significant correlation, χ = 4.85; p = 0.03, p <0.05.  The foramina in left (89.5%) and right (96.4%) femur were commonly observed at their middle third, with no statistically significant correlation between position of foramen accordingly to Foraminal Index value and side of extremity on which femur belongs (p=0.56; p>0.05). There is positive correlation between length of right and left femur and number of foramina.Conclusions: The study provides data of the nutrient foramina on femur, which is helpful for clinicians to help preserve bone vascularization during surgery.

Introduction: High opening injection pressure (> 15 psi) can detect needle nerve contact. However, the reliability of injection pressure monitoring to detect needle – nerve or impingement may be affected by syringe size. We hypothesized that monitoring of opening injection pressure (the pressure at which injectate is detected by US) is affected by the size of the syringe used for injection. Methods: After Ethics Commitee approval, 22 gauge 50 mm needles were inserted under US to contact the C5, C6 and C7 nerve roots of fresh human cadavers. Hand-held injections were made using 3 different syringe sizes (5, 10, 20 mL) at a rate commensurate with typical clinical practice. Injections were made bilaterally at each of the above nerve roots. Opening injection pressure data were aquired with an in-line digital pressure recorder using a 60 mL syringe (10ml/min), and injection halted when spread was detected. Results: A total of 48 injection measurements were made. The peak (opening) pressures at which injection commenced in two cadavers were 30.50 psi and 34.07 psi with 5 mL syringe, 29.20 psi and 34.95 psi for 10 mL syringe, 26.03 psi and 29.42 psi for 20 mL syringe, all han-held injection. In automated pump injection 60 mL syringe was used, and maximum achieved pressures were 23.42 psi and 34.03 psi. Opening injection pressures were similar regarless of syringe size (p>0.05). Conclusion: The size of the syringe commonly used in clinical practice of peripheral nerve blockade did not significantly affect the monitoring of the open injection pressure. All injection with the needle – nerve contact resulted in injetion pressure > 20 psi, regardless of syringe size or method of injection. Our findings ate thus consistent with the fluid mechaminc described by Pascal's Law, where pressure exerted anywhere in a confined incompressible fluid system is transmited equally throughout until the opening pressure is reached and injection begins.

Objectives: The main objective of the study is to give a detailed overview of the nutrient foramina and nutrient channels by macroscopic examination of fibula dyaphisis and to determine its utmost important variations for clinical practice. Methods and Materials: This was a cross-sectional-descriptive study in which we observed 50 fibula. We considered only nutritional foramina located at diaphysis of the bone. During the research we determined the following parameters: total number of nutrient foramina on dyaphisis of each bone, value of Foramina Index (FI), the length of the bones, the position of the nutritional foramina regarding to values of FI, and position of nutritionl foramina on the sides of the diaphysis of bone and the obliquity of nutrient canal. The obtained data were statistically analysed using SPSS version 17.0. Results: Nutritional foramina were recorded at 84.0% fibula. In 57.1% fibula nutritional foramina were placed on the facies posterior, in 40.5% on the facies medialis and on 2.4% bones nutritional foramina were on the facies lateralis. All fibula had nutritional foramina located on the middle third of the diaphysis of bone. Distally directed nutritional canals were observed on 90.5% fibula and proximally directed nutritional canalas were observed on 9.5% fibula. There was a negative correlation between the length of the fibula of the right and left limb and the number of nutritional foramina. Conclusion: Knowledge of the topography of nutritional foramina helps preserve bone vascularization during surgery. Keywords: nutritional artery, nutritional canals, fibula, topography

Background: The use of peripheral nerve blocks for anesthesia and postoperative analgesia has increased siginificantly in recent years. Many additives to local anesthetics to prolong the duration of analgesia for peripheral nerve blocks have been studied. Dexamethasone has been studied as an effective adjuvant to prolong the analgesia duration of local anesthetics in peripheral nerve block. However, the route of action for dexamethasone and its potential neurotoxicity are still unclear. The aim of this study is to determine possible toxic effects of dexamethasone on peripheral nerve tissue and the dependence of these effects on the place of intraneural applications. Methods and Materials: A rat sciatic nerve block model was used.  The study was conducted in accordance with the principles of laboratory animal care and was approved by the Laboratory Animal Care and Use Committee. Fifty adult Wistar rats (300 g) both sexes were studied. After induction of general anesthesia, the sciatic nerve was exposed bilaterally. Sciatic nerves were randomly assigned by the method of sealed envelopes to recive: intraneural, intrafascicular 2 mL of lidocaine with dexamethasone  (n=25), intraneural, extrafascicular injection  2 mL of lidocaine with dexamethasone (n=25),  perineural 2 mL of lidocaine with dexamethasone  (n=25) and perineural 2 mL of saline 0.9%  (n=25). Injection pressure was continuosly recorded using an in-line digital manometer. Increased injection pressure was used to distinguish intrafascicular from extrafascicular inrtaneural injections. After injection, the rats were awakened and subjected to serial neurologic examinations. Neurologic examination protocol was followed to determine proprioception by tactile placement response, motor function by extensor postural thrust and nociception by withdrawal reflex. On day 3 of the experiment, the animals were sacrificed and the neural tissue histologically examined. Results: Intraneural injections (intrafasciculary and extrafasciculary) of lidocaine in combination with dexamethasone caused neurological deficits and severe pathohistological damage to nerve fibers. All perineural injections (independent of the tested solution), combined with low injection pressure showed a uniform changes, with minimal histological deviation of the normal structure of the nerve fiber. Conclusions: When applied intraneuraly dexamethasone in combination with lidocaine caused nerve fiber damage. However, future studies are required to elucidate the most effective route and optimum dosing range for dexamethasone’s use in this field.

Background: Intraneural (intrafascicular) injection of various solutions can result in a mechanical injury to the fascicle(s). Additional injury can be expected when injectate has neurotoxic properties. In this study we examined the neurologic consequences of intraneurally injected lidocaine 2% and 0.9% NaCl. We postulated that intraneural injection of lidocaine 2% results in greater and longer-acting neurologic deficit in rats compared to intraneural injection of 0.9% NaCl. Methods and Materials: The study was conducted in accordance with the principles of laboratory animal care and was approved by the Laboratory Animal Care and Use Committee. Twenty four adult Wistar rats (300 g) both sexes were studied. After induction of general anesthesia (ether), the median nerve was exposed bilaterally. Under direct vision, a 27-gauge needle was placed either perineurally (n=24) or intraneurally (n=24), and 3 mL of preservative-free lidocaine 2% or 0.9% was injected using an automated infusion pump (3ml/min). Injection pressure data were acquired using an in-line manometer coupled to a computer via an analog-to-digital conversion board. After injection, the rats were awakened and subjected to serial neurologic examinations. Neurologic examination protocol was followed to determine grip strength and toe pinch reaction. Day 7 of the experiment, the animals were sacrificed and the neural tissue histologically examined. Results: Over the week following the procedure, all animals in both injection protocols (intraneural and perineural) initially lost and subsequently regained grip strength and paw pinch withdrawal reflex. Animals in the perineural group fully recovered grip strength and toe pinch score within 24-hours of surgery; the saline group showed more rapid recovery. In contrast, neither the lidocaine 2% or 0.9% saline intraneural group fully recovered a grip strength or toe pinch until the 7th or 4th day of recovery, respectively. There were no differences in the extent of neurologic impairment or speed of recovery between the saline and lidocaine 2% groups. Post-hoc comparisons of the four injection group by treatment condition effect at each testing interval post-surgery showed superior recovery in the perineural injected preparations at all intervals tested after hour 4 (p < 0.001). The average peak pressure for the intraneural injection group was 80.96 ± 20.94 kPa versus 21.63 ± 5.58 kPa for the perineural injection group (p < 0.0001). Histologic features of the injured tissues ranged from perineural ablation, cellular infiltration to destruction of neural architecture and axonal degeneration in intraneural preparations. No differences in this regard were found between lidocaine 2% and saline 0.9% groups. Conclusions: Intraneural injection of lidocaine 2% or 0.9% NaCl result in an indistinguishable neurologic deficit that is similar both in extent and duration. Intraneural injection is associated with significantly higher injection pressure as compared to the perineural injection. These results suggest that the main mechanism of neurologic injury resulting from an intraneural injection of lidocaine 2% may be a mechanical, injury to the fascicle(s), rather than a direct neurotoxicity.