Background and Objectives: The current intensity at which a motor response is elicited with an intraneural needle placement has been inadequately studied. We hypothesized that electrical current delivered through an intraneurally placed needle does not always result in an evoked motor response. Our secondary objective was to determine the relationship between electrical current intensity and needle-to-nerve distance. Methods: Twenty pigs were given general anesthesia and the sciatic nerves (SN) were exposed bilaterally. Electrical nerve stimulation was applied 2 cm, 1 cm, 0.5 cm, 0.2 cm, and 0.1 cm away from the SN, transepineurally, and intraneurally (in the subepineurium). Stimulation was started at 2.0 mA and decreased to the minimal current at which visible motor response was obtained. Two blinded observers agreed on the intensity and type of motor response. Specific response of SN was defined as a distal motor response (hoof twitch); nonspecific response was defined as a local muscle twitch (no hoof response). Results: At a distance of 0.5 cm to 2 cm away from the SN, only nonspecific muscle responses were observed. Specific SN responses were obtained starting at 0.1 cm away from the nerve and transepineurally with currents of 0.92 ± 0.33 mA (median 1.00 mA; range 0.24-1.48 mA) and 0.39 ± 0.33 mA (median 0.3 mA; range 0.15-1.4 mA), respectively. With the needle tip positioned intraneurally, specific motor response could be obtained at 0.56 ± 0.54 mA (median 0.3 mA; range 0.08-1.80 mA). Five (12.5%) intraneurally positioned needles only elicited a specific motor response at 0.8-1.8 mA. Conclusions: Specific response to nerve stimulation with currents <0.2 mA occurred only when the needle tip was positioned intraneurally. However, motor response could be absent with intraneural needle placement at a current intensity of up to 1.7 mA.

Background:  Inadvertent intraneural injection of local anesthetics may result in neurologic injury. We hypothesized that an intraneural injection may be associated with higher injection pressures and an increase in the risk of neurologic injury.

The blockade of peripheral nerves carries a certain risk of unwanted complications, which can follow after unintentional intraneural injection of a local anesthetic. Up till today, the research of measuring injection pressure has been based on animal models, even though the histological structure of periphery nerve is different for animal and human population, so the application pressure which presages intraneural injection in human population is still unknown. As material in performing this study there have been used 12 Wistar rats and 12 delivered stillborns. After bilateral access to the median nerve, we applied 3 ml of 2% lidocaine with epinephrine, with the help of automatic syringe charger. The needle was at first placed perineural on one side, and then intraneural on the other side of both examination groups. During every application the pressure values were monitored using the manometer, and then they were analyzed by special software program BioBench. All perineural injections resulted with the pressure < or = 27.92 kPa, while the majority of intraneural injections were combined with the injection pressure > or = 69.8 kPa. The difference between intraneural and perineural injection pressures for the two different examination groups (rats and delivered stillborns) was not statistically significant (P>0.05). As prevention from intraneural injections today are in use two methods: the method of causing paresthesia or the method of using the peripheral nerve stimulator. However the nerve injury can still occur, independent from the technique used. If our results are used in clinical practice on human population, than the high injection pressure could be the marker of intraneural lodging of a needle.

Cerebral-vascular diseases present one of the leading problems of the modern mankind. They are followed by the risk of high mortality rate, and as such cause high level of disability with people who survive cerebral-vascular incident (stroke, apoplexy). Researches done so far proved that beginning, course and result of the cerebral-vascular diseases depend immensely of the possibility to establish collateral blood circulation and first of all on so called tertian level that is actually the circle of Willis. The circle of Willis, thanks to communicating segments, provide detour way to procure parts of the brain which, due to insufficiency, do not get enough quantity of blood. In this particular study by the analysis of 150 MRI patient's angiographies of the circle of Willis that had been processed at the Radiology Institute of the Clinic Center of University in Sarajevo, we tried to present the most common variations of the posterior segment of the circle of Willis with patients who did not have signs of the cerebral-vascular diseases. The analysis included two target groups (above 60 years old and younger than 34 years old) and both genders. By the analysis of the angiographies of the circle of Willis we reached following results: complete posterior configuration of the circle of Willis has been found with all patients in 54% of cases, but in some slightly higher percentage complete posterior configuration is noted with younger category of patients compared to elderly patients, and in some higher percentage with female compared to male patients. Out of variations that damage the posterior segment of the circle of Willis the first one, according to the frequency of occurring, is the variation of the type of unilateral fetal sort of posterior cerebral artery, and then the variation marked as unilateral aplasia or hypoplasia of the posterior communicating artery.

In the last few decades there has been a great development of regional anesthesia; all the postulates are defined and all the techniques of usage are perfected. However, like any other medical procedure, the block of brachial plexus carries a risk of certain unwanted complications, like possible intraneural and intravascular injections. The reason for great discrepancy between the injury of brachial plexus and other periphery nerves while performing the nerve blockade is the frequent usage of this block, but also the specific proximity of neurovascular structures in axilla. The purpose of this work is to determine the values of pressures which appear in para-neural, intraneural and intravascular injection applications of local anesthetic, and to compare those values in order to avoid cases of intraneural and intravascular injections in clinical practice with consequential complications. In experimental study there have been used 12 Wistar rats of both genders. After anesthesia with ether and mid-humoral access to the neurovascular structures in axilla, the injection of 2% lidocaine with epinephrine was performed with the help of automatic syringe charge. The needle was at first placed para-neural, and then also intraneural and intravascular. During every application the pressure values were monitored using the manometer, and then they were analyzed by special software program. All para-neural injections resulted with the pressure between 13,96-27,92 kPa. The majority of intraneural injections were combined with the injection pressure greater than 69,8 kPa, while the intravascular injections were combined with injection pressure less than 6,98 kPa. Based on the available data it can be noticed that so far none of the methods of prevention from unwanted complications of regional anesthesia can insure the avoidance of intraneural and intravascular injection of local anesthetic. Based on our research it is obvious that the measuring of pressure during the nerve blockade is very important in order to decrease the risk of neurological and possible systematic complications. It is also clear that a small, mobile, and financially quite available apparatus for pressure measurement can help in differentiation between para-neural, intraneural and intravascular injection. Avoiding high injection pressure prevents from lodging the needle into intraneural space, while avoiding a very low injection pressure prevents from lodging the needle into intravascular space followed by consequential complications. The usage of this apparatus can find its application in other blockades of periphery nerves, and in other branches of medicine as well.

Histological changes of sciatic nerve in adult dogs 7 days after single application of 2% lidocaine (4 ml dose, speed of injection 3 ml/min) and measurement of the application pressure was studied, with a goal to investigate structural changes of the nerve in relation to the established pressure values. The application pressure was determined by using Bio Bench software. In intrafascicular puncture an average application pressure of 198.23 +/- 52 kPa was found, and in interfascicular puncture its average value was 53.3 +/- 17.9 kPa, with a note that individual differences are regularly present. Seven days after the injection, a nerve dissection was performed and serial sections covering the region of injection's puncture and bordering proximal and distal zones, in the total length of 3 cm, were prepared. The found changed show the presence of nerves' fibers lesions with a strong reactivity of Schwann's cell, as well as the change of interstitial structure concerning hypercellularity and occurrence of cellular extravasation. The covering system of the nerve in the zone of epineurium manifests changes of inflammatory process and in perineurium a decomposition of lamella layers and the alteration of their tinctorial properties were noticed. A comparison of the found nerve reactivities in intra- and interfascicular application showed their one-way alteration, although the lesions were more noticeable in the conditions of intrafascicular application. The damages were mostly expressed in the zone of local application of anesthetic, than distally from it, while the damage to the structure in the proximal part is of the smallest degree.

As it is well known the beginning, the course and the result of the cerebral-vasculare disease depends on, among other stuff, the possibility of establishment of the brain collateral circulation. The Willis's artery circle based on brain is the most important anastomoses between the blood circulation of the both, carotid and basilar artery. However, in almost half of the cases of the examined circle of Willis, certain deviations from the normal anatomy configuration have been identified that immensely facilitate occurance of vascular diseases, because it makes difficult establishment of collateral blood circulation. In this particular study, 150 MRI patient's angiographics had been analyzed that were processed at the Radiology Institute of the Clinic Center of the University of Sarajevo. The morphologic variations of the circle of Willis were analyzed on these angiographics and those were patients who did not have any signs of cerebral-vasculare diseases. We have tried to determine which variations are the most commonly occuring in the front segment of the circle of Willis with two target groups (older -- above 60 years old and younger- up to 34 years old) and including both genders. The method of the MR angiography in two projections enabled good visualisation of all components of the circle of Willis and based on their analysis we have achieved the following results. The complete front configuration of the circle of Willis had been found with all patients in 76,7% of the cases. We noted slightly higher percentage of the anterior configuration with younger category of patients compared to older patients, and with males compared to females. Out of the variations that damage the anterior segment of the circle of Willis, the first one, according to the frequency of occuring, is the variation of the type of hypoplasia or aplasia of Al segment of the anterior cerebral artery, and then the variation marked as duplication or multiplication of the anterior communicating artery.

Telemedicine (distance medicine) represents a field of medicine that has been in a tremendous expansion over the last couple of years thanks to the fast development of telecommunications and reduction of their costs. It enables a direct communication (visual) between the peripheral hospitals and referral facilities in the interior of the country as well as a connection of centres with referral centres abroad in the fields of diagnostics, consultations or education. The main objective is to encourage interest in telemedicine among physicians and other health care experts, initiate an exchange of opinions, and experience about the application of telecommunication technology in medicine, so to reach a common perception of its role in the context of future development of the health care system in Bosnia and Herzegovina. As a standard, current equipment consists of computers, which are equipped with frame grabbers and communication modem for communication through a public telecommunication system. Input data can all be visual data (X-Ray, CT, MRI, ultrasound, ECG, histological finding, cariogram, and of course photos of the patients, of operational/surgical field. The Institute of Pathology of the Sarajevo Medical Faculty has actively participated in the experimental project "SHARED" (1996-2000) together with the Radiology and Ophthalmology Clinic of the Sarajevo Clinical Centre. The past experience in using telemedicine has shown that the introduction of such a telemedicine system in B&H would be of great significance in the future in the context of providing better and more efficient health services to the patients. In practice, that means a more simple approach to some services and data for patients, a better and faster circulation of information and experience of medical experts and health care workers with cost control at the same time.

In this paper, we described osseous anatomy of the orbital apex using CT in axial and coronal projections. The main osseous landmarks facilitate the evaluation of orbital apex in radiology, especially on the axial and coronal CT scans. These landmarks include so called optic strut, small segment of the greater wing of the sphenoid bone and upper part of the pterygopalatine fossa. We also concentrate attention upon visualisation and review of the optic canal, superior and inferior orbital fissure, pterygopalatine fossa and foramen rotundum.

Pterygopalatine fossa represents very important topographic area, which is connected, by numerous foramina and fissures, to the other extracranial and intracranial areas. This gives to it huge anatomic and clinical significance. In these papers, through the method of computed tomography in axial and coronal projections, we have presented pterygopalatine fossa and the communications that it can establish through foramen rotundum (the middle cranial fossa), inferior orbital fissure (orbital cavity), sphenopalatine foramen (nasal cavity), greater palatine foramen and lesser palatine foramina (oral cavity), canalis pterygoideusa (nasal part of throat) and pterygopalatine fissure (infratemporal fossa). Knowledge on pterygopalatine fossa, and its communications, too, is necessary for adequate evaluation of the infective and tumourous processes, by which it might be primarily or secondarily taken.

OBJECTIVES The objective of this work is studying wariable anatomy formations at the posterior border of the pterygoid process lateral plate of the sphenoid hobe (lig. et foramen pterygospinale, lig. et foramen crotaphitico-buccinatorium), and its statistical processing considering sex, age and sides of studied sculls. MATERIAL AND METHODS At 305 sculls of mature persons of both sexes (167 males and 138 females) we studied incompletely ossificated lig. pterygospinale, opening of the same name which has become by its full ossification, incompletely ossificated lig. crotaphitico-buccinatorium and opening made by it's complete ossification, and position of this structures in relation to foramen ovale. RESULTS Incompletely ossificated lig. pterygospinale was found at 12 sculls on both sides or 3.93% (8 male's and 4 female's sculls). One-sidedly, on the right one, incompletely ossificated lig. pterygospinale was found at 14 sculls (4.59%), and on the left side at 19 sculls (6.22%). Incompletely ossificated lig. pterygospinale, present on both sides of sculls, was in the case of persons older than 50 (9 sculls or 75%). Pterygospinous opening which has become by complete ossification of lig. pterygospinale was found on both sides at 4 sculls (1.31%), two of them were male's and two of them female's sculls. In alll four cases persons were older than 40. Pterygospinous opening found on the left side was present at only 3 sculls (0.98%) and on the right side at 4 sculls (1.31%). Pterygospinous opening was present one-sidedly, every time, in the case of male's sculls. Incompletely ossificated lig. crotaphitico-buccinatorium, meaning incomplete opening, was found at 17 sculls on both sides (5.57%). 10 of them were male persons' sculls, and 7 of them females'. On the right side, incompletely ossificated lig. crotaphitico-buccinatorium was found at 11 sculls (3.60%)--6 male's and 5 female's, and on the left side at 16 sculls (5.24%). Foramen crotaphitico-buccinatorium was found on both sides only at 12 sculls (0.97%)--one male's and one female's. Foramen crotaphitico-buccinatorium was found on the left side at 8 sculls (3.90%) and, on the right side, this opening was found at 3 sculls (0.98%). Incompletely of completely ossificated lig. pterygospinale, located laterally from foramen ovale, was found at 5 sculls (5 male's and 1 female's) or 1.63%, and in the other case, incopletely or completely ossificated lig. crotaphitico-buccinatorium laterally from foramen ovale was found at 7 sculls (5 male's and 2 female's) or 2.29%. CONCLUSION While applying conductive anaesthesia on mandibular nerve by lateral subzygomatic route, variable ossificated formations at lateral plate's posterior border of pterygoid process should be kept in mind. It is possible that a needle, at a depth of 35 mm, comes across incompletely or completely ossificated lig. pterygospinale et crotaphitico-bucciantorium. Based on ours anatomy research we concluded that these formations are more oftenly present on males aged over 50, and that one-sided presence is more often on the left side. Ossificated formations which were the object of our research are not an obstacle to high-quality applying of conductive anaesthesia on trigeminale ganglion et mandibular nerve each time when they exist, but only when they are located laterally from foramen ovale, what appeared at 12 sculls (3.93%) in our case.