UNLABELLED Atherosclerosis is a systemic disease of blood vessels which in most of the cases affects two or three vascular beds. The occurrence and development of atherosclerotic disease is accelerated by multiple risk factors among which the significant role has arterial hypertension and diabetes mellitus. AIM of this article is to evaluate presence of hypertension and diabetes mellitus type 2 in patients with polyvascular atherosclerotic disease and compare them to those who have isolated disease of one vascular bed. MATERIAL AND METHODS we enrolled total of 160 consecutive patients. Patients were divided into 4 groups, in relation to the type of their atherosclerotic disease. COR-group included patients with coronary atherosclerotic disease, CAR-IF group included patients with carotid and iliac-femoral atherosclerotic disease, COR-IF group consists of patients with coronary and iliac-femoral atherosclerotic disease, and COR-CAR-IF group consists of patients with atherosclerotic disease in three vascular beds: coronary, carotid and iliac-femoral. We followed clinical variables: age, gender, arterial hypertension, tobacco smoking, total cholesterol and diabetes mellitus with focus on arterial hypertension and diabetes mellitus. RESULTS we had significant percentage of patients with arterial hypertension in all four groups in relation to those with normal blood pressure. Hypertension in male subjects was significantly higher in those with polyvascular disease i.e. COR-CAR-IF, and COR-IF groups, compared to monovascular disease i.e. COR group, (p < 0.05). In females the prevalence of hypertension was significantly higher in COR-CAR-IF and COR-IF groups, (< 0.05). Males had higher systolic values in the COR-CAR-IF group compared to other groups, but only signif. differ. was between COR-CAR-IF group vs. CAR-IF group, (p < 0.05). In females we found signif. differ. in systolic values in COR-CAR-IF group compared to COR group, p < 0,05. In diastolic values we found no signif. differ. between groups. The significant percentage of diabetics was in COR-CAR-IF group (77.5%), and the difference to other groups was statistically significant, p < 0.05. We found significant percentage of diabetics in COR-CAR-IF group (77.5%), and the difference between the diabetics versus non-diabetics was statistically significant. The largest percentage of diabetics both men (76.1%) and women (84.2%) belonged to the patients with polyvascular disease i.e. COR-CAR-IF group respondents. CONCLUSIONS prevalence of arterial hypertension and type 2 diabetes mellitus was statistically higher in individuals with polyvascular atherosclerotic disease.

INTRODUCTION Atrial myxomas are the most frequent benign tumors of the heart. Left atrial myxomas are about 3-4 times more frequent then right. Clinical findings reveal atrioventricular obstruction symptoms and signs, symptoms and signs of peripheral arteries or pulmonary artery embolisation and/or nonspecific symptoms. AIM Review of atrial myxomas diagnosed at the Clinic of Cardiology in 20 years period and analysis of clinical characteristics, transthoracic echocardiographic (TTE), transesophageal echocardiographic (TEE), and M-mod echophonographic findings. METHODS TTE is performed in all, but TEE in 16 patients. Simultaneous M-mod echophonocardiographic examination were performed in 11 patients, when optional equipment was applicable. RESULTS We found 24 atrial myxomas: 19 (79.2%) in left and 5 (20.810%) in right atrium. 21(87.5%) patients had some of the symptoms, but 3 (12.5%) were asymptomatic. TTE was performed in all patients, but we found 1 (2.4%) false negative result. TEE was performed in 14 (58.3%) patients. Echophonocardiographic recordings showed early diastolic tumor "plop" in 10 patients and unusual late diastolic tumor "plop" in one right atrial myxoma, which has not yet been described. CONCLUSIONS TTE is a reliable method in diagnosis of atrial myxomas, but not in all cases, while TEE has been found as always reliable. Echophonocardiographic recording is useful for confirmation and understanding of auscultatory finding when applicable.

AIM There are no previous data about the anti-inflammatory effects of hypolipemic agents, statins, in patients after aortocoronary bypass grafting. The aim of this study was to demonstrate effects of simvastatine on postoperative treatment, laboratory findings and pericardial effusion during postoperative period, in patients after aortocoronary bypass grafting procedures. MATERIAL AND METHODS The study included 80 patients with coronary arterial disease divided in two groups. The study group included 40 patients with coronary ischemic disease subjected to surgical implantation of aortocoronary bypass graft who received standard cardio-surgical postoperative treatment supplemented with 40 mg of simvastatine per day, starting at 8 hours after the patient's extubation until postoperative 14th day. The control group included 40 patients after aortocoronary bypass grafting procedures with standard intensive postoperative treatment. Evaluation included demographic data, surgical reports, postoperative laboratory parameters and echocardiography findings, taken during two days monitoring of postoperative pericardial effusion. Statistical data analysis was conducted using SPSS software. Parametric data were evaluated using Student T-test, while non-parametric data were processed using chi2 test and proportion analysis. Mann-Whitney U test was applied with CI of 95%, i.e., significance level p < 0.05. RESULTS No significant differences were found between the observed groups with regards to demographic data, number of the implanted aortocoronary bypasses and postoperative laboratory parameters. However, the differences in echocardiographically determined dimensions of postoperative pericardial effusions measured during two days of postoperative observation (between the 3rd and the 14th day postoperative) were significant (p < 0.037, p < 0.01). CONCLUSION In our study, statin therapy consisting of 40 mg/24 hrs was applied with no side effects and without interaction with the other postoperatively applied medications. Simvastatins, applied in the dosage of 40 mg/24 hrs, efficiently lead to significant reduction of postoperative pericardial effusions in postoperative period. In this limited group of patients, statins have exhibited good anti-inflammatory effects. Statins with standard therapy ought to be included in the early cardio-surgical postoperative period. Anti-inflammatory activities of statins should be further investigation on much larger patient sample. So far, there is no record of a large study of anti-inflammatory activities of hypolipemic agents that could waive the doubts into their effectiveness. It needs to be stressed that no large studies of anti-inflammatory activities of hypolipemic agents in cases of postoperative pericardial effusion were ever conducted.

At the end of IX and beginning of the X century begins development and renaissance of the medicine called Arabic, and which main representatives were: Ali at-Taberi, Ahmed at-Taberi, Ar-Razi (Rhazes), Ali ibn al-Abbas al-Magusi (Haly), ibn al-Baitar, ibn al-Qasim al-Zahrawi (Abulcasis), ibn Sina (Avicenna), ibn al-Haitam (Alhazen), ibn Abi al-Ala Zuhr (Avenzor), ibn Rushd (Averroes) and ibn al-Nafis. Doctors Taberi, Magusi and Razi were born as Persians. Each of the listed great doctors of the Arab medicine in their own way made legacy to the medical science and profession, and left lasting impression in the history of medicine. Majority of them is well known in the West well and have their place in the text-books as donors of significant medical treasure, without which medicine would probably, especially the one at the Middle dark century, be pale and prosaic, insufficiently studied and misunderstood, etc. Abdullah ibn Sina (Avicenna) remained unsurpassed in the series of above listed. Close to him can only come Alauddin ibn al-Nafis, who will in mid-XII century rebut some of the theories made by Avicenna and all his predecessors, from which he collected material for his big al-Kanun fit-tibb (Cannon of medicine). Cannon will be commended for centuries and fulfilled with new knowledge. One of the numerous and perhaps the best comments-Excerpts is from Nafis-Mugaz al-Quanun, article published as a reprint in War Sarajevo under the siege during 1995 in Bosnian language, translated from Arabic by the professor Sacir Sikiric and chief physician Hamdija Karamehmedovic in 1961. Today, at least 740 years since professor from Cairo and director of the Hospital A-Mansuri in Cairo Alauddin ibn Nefis (1210-1288), in his paper about pulse described small (pulmonary) blood circulatory system and coronary circulation. At the most popular search engines very often we can find its name, especially in English language. Majority of quotes about al-Nafis are on Arabic or Turkish language, although Ibn Nafis discovery is of world wide importance. Author of this article is among rare ones who in some of the indexed magazines emphasized of that event, and on that debated also some authors from Great Britain and USA in the respectable magazine Annals of Internal medicine. Citations in majority mentioning other two "describers" or "discoverers" of pulmonary blood circulation, Miguel de Servet (1511-1553), physician and theologian, and William Harvey (1578-1657), which in his paper "An Anatomical Exercise on the Motion of the Hearth and Blood in Animals" published in 1628 described blood circulatory system. Ibn Nafis is due to its scientific work called "Second Avicenna". Some of his papers, during centuries were translated into Latin, and some published as a reprint in Arabic language. Significance of Nafis epochal discovery is the fact that it is solely based on deductive impressions, because his description of the small circulation is not occurred by in vitro observation on corps during section. It is known that he did not pay attention to the Galen theories about blood circulation. His prophecy sentence say: "If I don't know that my work will not last up to ten thousand years after me, I would not write them" Sapient sat. Searching the newest data about all three authors: Alauddin ibn Nafis (1210-1288), Michael Servetus (1511-1533) and William Harvey (1628) in the prestige Wikipedia I manage to link several most relevant facts, based on which we can in more details explain to whom from these three authors the glory and the right to call them self first describer of the pulmonary and cardiac circulation belongs. About Servetus and Harvey there is much more data than on ibn Nafis, about which on Google there are mainly references in Arabic and Turkish language, and my four references on Bosnian, with the abstracts in English. Probably the language barrier was one of the key reasons that we know so little about Nafis and so little is written, although respectable professor Fuat Sezgin from Frankfurt in 1997 published comprehensive monograph about this great physician, scientist and explorer, in which papers we can clearly recognize detailed description of the pulmonary and cardiac circulation. Also, I personally published separate monographs about this scientist, and which can be found on www. avicenapublisher.org.

Today, at least 740 years since professor and director of the Al Mansouri Hospital in Cairo Ibn al-Nafis (1210-1288), in his paper about pulse described small (pulmonary) blood circulatory system. At the most popular web search engines very often we can find its name, especially in English language. Majority of quotes about Ibn Nefis are on Arabic or Turkish language, although Ibn Nefis discovery is of world wide importance. Author Masić I. (1993) is among rare ones who in some of the indexed journals emphasized of that event, and on that debated also some authors from Great Britain and USA in the respectable magazine Annals of Internal Medicine. Citations in majority mentioning other two "describers" or "discoverers" of pulmonary blood circulation, Michael Servetus (1511-1553), physician and theologist, and William Harvey (1578-1657), which in his paper "Exercitatio anatomica de motu cordis et sanguinis in animalibus" published in 1628 described blood circulatory system. Ibn Nefis is due to its scientific work called "Second Avicenna". Some of his papers, during centuries were translated into Latin, and some published as a reprint in Arabic language. Professor Fuat Sezgin from Frankfurt published a compendium of Ibn Nefis papers in 1997. Also, Masić I. (1997) has published one monography about Ibn Nefis. Importance of Ibn Nefis epochal discovery is the fact that it is solely based on deductive impressions, because his description of the small circulation is not occurred by observation on corps during section. It is known that he did not pay attention to the Galen's theories about blood circulation. His prophecy sentence say: "If I don't know that my work will not last up to ten thousand years after me, I would not write them". Sapient sat.

INTRODUCTION There are very few studies analysing blood flow velocity parameters of common carotid arteries (CCA), obtained with color Doppler examination as a predictor in cerebrovascular events (CVE). In everyday clinical practice there are number of patients (pts) without carotid stenosis or occlusion but with decreased blood flow velocities. AIM We performed this study to compare data of velocity parameters with type of cerebrovascular events (CVE) and multiple risk factors in patients without stenotic or occlusive extracranial disease. METHODS We included total of 127 consecutive patients who experienced various subtypes of cerebrovascular events, 68 females, 59 males, mean age 70.2 +/- SD 12.4 years, out of them 48 pts. had transients ischemic attacs (TIAs), 31 pts. had recurrent TIAs (recTIAs), 32 pts. developed ischemic stroke (IS), and 16 recurrent IS (recIS). All patients were without hemodynamically significant carotid stenosis or occlusion. As a control group we took 50 patients with comparable mean age and gender distribution, all without cerebrovascular events, but with at least 1 multiple risk factor. We included the following clinical variables: age, gender, hypertension, tobacco smoking, hyperlipidemia, obesity, diabetes mellitus. Velocity parameters were: peak-systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), resistive index (RI). Examination was performed on distal portion of CCA, and we took the mean of both CCA. RESULTS Hemodynamic parameters in CVE pts were: PSV 83.5 cm/sec, EDV 19.5 cm/sec, PI 1.54, and RI 0.77, and in Controls values were: PSV 87.5 cm/sec, EDV 28.5 cm/sec, PI 1.42, RI 0.67, respectively. No sign. diff. in PSV and PI were found between CVE (n=127) and Controls (n=50), p = 0.2, while difference in EDV was significant, p < 0.01. We found significance for the following variables: age, tobacco smoking, hypertension, hyperlipidemia and obesity. The best single predictors for CVE were: age (70.1%, p < 0.01), tobacco smoking (63%, p < 0.01, hypertension (52.8%, p < 0.01) and obesity (51.2%, p < 0.01). and among hemodynamic parameters, end-diastolic velocity less than 18 cm/sec (p < 0.05). Decreased EDV (below 18 cm/sec) revealed a significant association with CVE. CONCLUSIONS (a) we found significantly lower EDV in pts with IS and recIS, (b) EDV below 18 cm/sec was the best single predictor of IS, and recIS, (c) in our CVE pts--age, tobacco smoking, hypertension, obesity, were the best single predictors for CVE.

INTRODUCTION There are very few studies analysing blood flow velocity parameters of common carotid arteries (CCA), obtained with color Doppler examination as a predictor in cerebrovascular events (CVE). In everyday clinical practice there are number of patients (pts) without carotid stenosis or occlusion but with decreased blood flow velocities. AIM We performed this study to compare data of velocity parameters with type of cerebrovascular events (CVE) and multiple risk factors in patients without stenotic or occlusive extracranial disease. METHODS We included total of 127 consecutive patients who experienced various subtypes of cerebrovascular events, 68 females, 59 males, mean age 70.2 +/- SD 12.4 years, out of them 48 pts. had transients ischemic attacs (TIAs), 31 pts. had recurrent TIAs (recTIAs), 32 pts. developed ischemic stroke (IS), and 16 recurrent IS (recIS). All patients were without hemodynamically significant carotid stenosis or occlusion. As a control group we took 50 patients with comparable mean age and gender distribution, all without cerebrovascular events, but with at least 1 multiple risk factor. We included the following clinical variables: age, gender, hypertension, tobacco smoking, hyperlipidemia, obesity, diabetes mellitus. Velocity parameters were: peak-systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), resistive index (RI). Examination was performed on distal portion of CCA, and we took the mean of both CCA. RESULTS Hemodynamic parameters in CVE pts were: PSV 83.5 cm/sec, EDV 19.5 cm/sec, PI 1.54, and RI 0.77, and in Controls values were: PSV 87.5 cm/sec, EDV 28.5 cm/sec, PI 1.42, RI 0.67, respectively. No sign. diff. in PSV and PI were found between CVE (n=127) and Controls (n=50), p = 0.2, while difference in EDV was significant, p < 0.01. We found significance for the following variables: age, tobacco smoking, hypertension, hyperlipidemia and obesity. The best single predictors for CVE were: age (70.1%, p < 0.01), tobacco smoking (63%, p < 0.01, hypertension (52.8%, p < 0.01) and obesity (51.2%, p < 0.01). and among hemodynamic parameters, end-diastolic velocity less than 18 cm/sec (p < 0.05). Decreased EDV (below 18 cm/sec) revealed a significant association with CVE. CONCLUSIONS (a) we found significantly lower EDV in pts with IS and recIS, (b) EDV below 18 cm/sec was the best single predictor of IS, and recIS, (c) in our CVE pts--age, tobacco smoking, hypertension, obesity, were the best single predictors for CVE.

AIM To evaluate whether diabetic patients differ from non-diabetic patients when referred for coronary angiography and coronary revascularization procedures regarding previous history, indications for and findings at coronary angiography as well as medications. PATIENTS AND METHODS Data were prospectively collected on 100 patients referred for consideration of the coronary revascularization. All patients were divided into two groups: 50 diabetic patients with coronary angiography exams and second group of 50 non-diabetic patients also with coronary angiography exams. Data were evaluated statically with SPSS program. We used Leven's variance test with CI: 95% and significance level p < 0.05. RESULTS Our data were shown no differences in age or sex in the two groups. In diabetic patients group the left ventricle volumes were greater, and more often presented myocardial walls segmental abnormalities, as well as depressed myocardial function (EF < 40%). Coronary angiography exams in diabetic group had shown greater changes in left main, proximal part of all coronary arteries. Three vessel diseases were more often present in diabetic groupe. CONCLUSIONS Number of bypass grafts were significantlly greater in diabetic groupe, what is expected because of differences in results already presented in our paper. Diabetes mellitus stayed metabolic syndrom which accelerated inflamatory, coagulation and atherotrombotic proccess as one of the main risk factors of the atherosclerosis of all vessels esspecially coronary arteries.

UNLABELLED WORK GOAL: to determine the influence of Left branch block Hissa (LBBB) on: (a) the degree of heart weakness according to NYHA classification; (b) structural remodelling based on echocardiographic, and (c) functional remodelling based on EFLV i FS (echo), comparing patients with heart failure (HF) and the left branch block Hissa (LBBB) on EKG with heart failure with heart failure (HF) without the left branch block Hissa (LBBB). METHODS AND WORK We selected group of So hospital patients with heart weakness of NYHA class II-IV with and 50 without the left branch block Hissa on EKG (LBBB). RESULTS There was a clinical and echocardiographic evaluation of all patients and we determined their correlation related to the sex, NYHA class, structural and functional remodelling of heart cavities, EFLV, FS and survival and the number of hospitalisation in the last three years. The results where shown in a form of a table SAS 9.13 was used for statistic analysis. DISCUSSION AND CONCLUSION LBBB is an important component of electric heart remodeling in patients with heart failure and represent an important clinic data in evaluation of patients and therapeutic approach. Because all our variables were expressed as a frequencies, chi square and Fisher exact test were used to test for potential differences. It particularly stressed the correlation of LBBB with echocardiographic movability parameters of i.v. septum and left atrium dimension (p < 0.001) while septum fibrosis (p < 0.001), paradoxal septum movability (p = 0.193) and EFLV (p < 0.001) point to a close correlation with LBBB. Other analysed parameters showed no correlation with LBBB.

A case of atherosclerotic changes with rare form of right sided Subclavian Steal Carotid Recovery Syndrom consisted of three elements: critical stenosis of brachiocephalic trunc (80%), mild stenosis of right common carotid artery (35%) and variable, ascendent-descendental filling of right vertebral artery is reported. A patient is in a high risk for developing of arterial occlusive disease and with high total score of 7 out of 10 multiple risk factors (age, personal or familiar history, smoking, hyperlipidaemia, overweight, sedentary lifestyle). A cervical spondylosis accompanied with chronic neural lesion of C7/C8 myotom is verified causing mistreatment of a patient exclusively as neurological or physiatrical case.

Pulmonary embolism (PE) and deep vein thrombosis (DVT), respectively venous thromboembolism (VIE), are relatively frequent diseases. Appropriate management of PE includes risk stratification, preventive and primary therapy. Appearance of the disease ranges from mild to severe, and rapid and accurate risk stratification is extremely important. So appropriate management can range from prevention of recurent PE with anticoagulant therapy alone in low risk patients, to clot disolution or embolectomy in high risk patients. Preventive therapy prevents recurent VTE including anticoagulant therapy with heparin (low molecular weight heparin-LWM or unfr actional UFH), direct thrombin inhibitors (DTI) or oral anticoagulants. Primary therapy includes thrombolitic therapy or embolectomy (catheter or surgical). Prevention DVT and VTE includes mechanical and pharmacological measures in internal medicine, in general, cancer and orthopedics surgery.

UNLABELLED Atherosclerosis, polygenetic, multifactorial and chronic progressive disease of arteries leaves significant consequences on organs and their systems and cause frequent hospitalisations of patients. Aim found out frequency of atherosclerosis process and its consequences (acute myocardial infarction, cardiomyopathy, cerebrovascular insult, renal diseases and diseases of peripheral blood vessels) together with risc factors (artery hypertension, diabetes mellitus, hyperlipidemia, smoking, obesitas, stress an so on.) at patients of Internal Clinic in Mostar in the last three years (2001; 2002; 2003). RESULTS AND METHODS During last three years we hospitalised 7278 patients which consequences and manifestations of arterosclerosis process had 4825 patients or 66.29% (male 2595 or 53.7% and female 2230 or 46.22%. Most frequent were CM (1496 or 31%) CAD (1036 or 21.47%) peripheral vessel diseases (169 or 3.5%) and the most significant CVI (104 or 2.15%) which were at our clinic as complication for other internal diseases.