Crankshaft Phenomenon refers to the loss of three-dimensional correction of the scoliotic curve which occurs after the back spine fusion is done to children who have not completely reached the skeletal maturity. Patients with infantile and juvenile idiopathic scoliosis are at the highest risk; however, this phenomenon also occurs in adolescents who are immature at the time of surgery. The aim of this study was to determine the relationship between the age of operated patients and the possible postoperative progression of scoliotic incurvation (The Crankshaft’s Phenomenon) after surgical correction of adolescent idiopathic scoliosis. The retrospective-prospective study was performed among 48 patients with adolescent idiopathic scoliosis, randomised selected, with both sexes included. All analyzed patients underwent a surgical correction of scoliosis through rear access, using the Isola's or the SSE (Spine System Evolution) implants. Correlation between presurgical and postsurgical values (at the end of the physiological growth) ​​of spine scoliosis part Cobb's Angle is investigated. The increase of the scoliotic part curvature (an average of 16.22%) in patients operated in the period of the intensive growth of the spine can be expected due to the ratio of the measured quantities of Cobb 's Angle, and the postoperative control examination in this group showed highly positive statistical correlation with r = 0.97 correlation factor . The less increase of the curvature of the spine (an average of 7.52 %) can be expected in patients operated in the period of stagnating growth of the spine and the relationship between measured values ​​of Cobb 's Angle and the postoperative control examination in this group showed a highly positive statistical correlation (correlation factor r = 0.98) as well. Individual size of the postoperative spinal curvature do not condition the size of the possible progression of the curvature.

The number of students who are enrolled in bilingual classes in Austrian Carinthia grows year by year. The program is being joined by a variety of students; these are young Slovenians of Carinthia whose mother tongue is Slovene, students from German speaking families who live in a bilingual area, students whose ancestors were Slovenes of Carinthia but due to different reasons have forgotten the Slovene language and only speak German or only speak Slovene in an older dialect of Carinthia, students who moved from Slovenia and their first language is Slovene and students who have moved from other countries. Classes in bilingual schools takes place in both German and Slovene language, half the time in one and half the time in the other language. When and how this is executed depends on the teachers. Students who are enrolled in bilingual classes enter the school with different levels of knowledge of the Slovene language and therefore the classes must be adapted, something the bilingual teachers are well aware of. The differentiation and individualization of bilingual classes in Slovene language are crucial as this is the only way to enable progress for all the participating students. The Masters thesis presents the system of working with the students who are enrolled in the bilingual school in Austrian Carinthia and are also enrolled in bilingual classes. The main point of the planned activities was to achieve progress in communicating abilities within the frames of spoken and written Slovene language. The theoretical section of the Masters thesis consists of nine chapters. The communicational ability is presented along with its development in class, understanding and learning the language, the factors that affect the learning of a different language, bilingualism, language transfer, methods and forms of work with bilingual classes, differentiation and bilingual schooling in Austrian Carinthia. The empirical part presents an active research that was formed and executed in the 1st class of a bilingual public school. As the students do not have the same abilities to conquer Slovene as a second language their knowledge levels differ at the start of the schooling. As a so-called language assistant, I have prepared a differential plan of teaching and then executed it with the students, whose first language is not Slovene. Based on the results of the research (the achievements of students on several written and oral exams) we can determine that the language assistant (when taking into consideration the foreknowledge of the students) can contribute to the development of communication ability in Slovene language with these types of students provided that their background knowledge, work knowledge, sensibly formed groups and work methods are taken into consideration.

Aim To establish presence of segmental instability in patients operated with standard discectomy comparing measurement of translation and rotation on postoperative functional radiographs of lumbosacral spine with reference values,and to explore difference between patients operated on one or two levels. Methods The study included 71 patients, who were operated due to herniated lumbar disc. They were divided into two groups operated on one level (group A) or two adjacent levels (group B). All patients had been imaged in a standing position with functional lateral radiography. Radiographic images were digitized and then computerized measurement of translation and rotation was made. Measurement data were compared between the groups and with reference values obtained in healthy adults. Results Standard lumbar discectomy leads to an increase in translation, however, it reached statistical significance only for L4/L5 level and a decrease of rotation, which showed statistical significance for all samples, relative to the reference values. There was no statistically significant difference in the values of translation and rotation between the groups for corresponding levels, except for the value of the rotation for L4/L5 level as adjacent, unoperated level. Comparison of translation and rotation between the operated and adjacent levels did not show a statistically significant difference. When it comes to comparing the measured and predicted translation, there was a statistically significant difference only at the L5/S1 as anunoperated level. Conclusion Standard discectomy does not lead to radiologically significant segmental instability, and two-level surgery has not caused more pronounced signs of instability comparing to onelevel surgery.

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.

UNLABELLED Anatomical variations of veins often play a crucial role in formation of thrombotic changes in superficial and deep veins of lower extremities. THE AIM of this study was to determine the frequency of the dominant type of the lower extremity superficial veins, and to determine the eventual influence of such variations to the formation of superficial and deep vein thrombosis (DVT). MATERIAL AND METHODS The sample used in this study consisted of 180 patients subjected to ascedent contrast phlebography of lower extremities. The total sample was divided into following groups: patients with and without variations of the lower extremity superficial veins. RESULTS AND DISCUSSION Dominant type of the superficial veins (without variation) consisted of 97 patients (53.89%), while the rest of 83 patients showed some kind of anatomical variation (46.11%). The most frequent variation was the duplicated form ofv. saphena magna in 53.85%, while this procentage in women was 57.89%. Most frequent variations of duplicated v. saphena magna were: simple duplicated form, closed loop form, branching form and combined form. Topographical variation of saphenopopliteal junction besides fossa poplitea in the group of men showed procentage of 53.85%, while in the group of women that value accounted 63.16%. CONCLUSION The percentage of varicose veins was more frequent in men and women without variations, but deep vein DVT showed higher frequency in patients with anatomical variations of superficial veins of lower extremities.

AIM To investigate a potential difference in postoperative morphological changes of two-level lumbar disc surgery as compared to one level surgery. METHODS The standard lateral radiographs of lumbar spine obtained preoperatively and postoperatively were used in the study . The morphological study included 60 adult patients of both sexes who had undergone the surgery in the period 2002-2006. The first group comprised patients operated on one level (L4/L5 and L5/ S1), and the second included patients operated on two levels (L3/ L4/L5; L4/L5/S1 and L5/S1/S2). Using lateral radiographs, after digitalization, the height of intervertebral disc space (HD), angle between vertebral bodies (A) and translation (T) were measured. RESULTS Comparing preoperative and postoperative values, statistically significant difference has been found for HD in the first group and HD and A in the second group. In neither groups there was statistically significant difference for T, which is one of radiological signs of segmental instability. The comparison of postoperative values for both groups has not shown any statistically significant difference. CONCLUSIONS The standard lumbar discectomy on two levels has not shown more pronounced morphological changes or changes suggesting an increased risk of segmental instability as compared to one level discectomy.

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.

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.

INTRODUCTION Anemia is an early sign of chronic kidney dysfunction, caused by many different factors, but the insufficient erythropoietin synthesis is the crucial factor in its development. OBJECTIVES The objective of our study was to compare effectiveness of epoietin alpha and beta application in the treatment of renal anemia in chronic hemodialyzed patients. PATIENTS AND METHODS The group included 60 patients of both sexes, randomly chosen. Criteria for including patients into the study were: older than 18 years, haemodialyzed longer than three months and treated by epoietin beta, stable level of hemoglobin, between 9 and 11 g/dL at least two successive measurements and no malignant disease present. The patients were then randomized into groups: 20 patients were administered epoietin alpha intravenously instead of epoietin beta subcutaneously (experimental group); 20 patients were administered intravenously epoietin beta instead of epoietin beta subcutaneously (control group A), the rest of 20 patients were administered epoietin beta subcutaneously (control group B). All the testees were administered epoietin alpha or beta three times weekly after haemodialysis, intravenously or subcutaneously. RESULTS Comparison among mean values of hematological and biochemical parameters before starting the treatment by erythropoietin, and third and sixth months after therapy in the studied groups, no significant difference was found (p > 0.05). CONCLUSION Epoietin alpha and beta showed approximate degree of efficacy in renal anemia treatment of hemodialysis patients. The way of erythropoetin administration did not significantly effect the level of hemoglobin and hematocrit in six months research period.

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.