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Proficiency in the anatomy of coronary arteries and their variations is significant for proper interpretation of the coronary angiographies, assessment of the complexity and result of the coronary insufficiency as well as surgical myocardium revascularization. The objective of this study is anatomy-radiology research of the methods of branching the main trunk of left coronary artery and to prove importance of the diagonal branch (ramus diagonalis) existence in the conditions of coronary insufficiency. In this study we have analyzed 100 coronary angiographies done at the Clinic for Heart Diseases and Rheumatism of the Clinic Center of University of Sarajevo and dissected 20 human hearts from the Institute of Anatomy. In our study we have come upon two methods of branching of main trunk of left coronary artery (bifurcation and trifurcation). By the method of the angiography we have found the bifurcation in 71% of cases while 65% of cases were proved by the dissection method. Trifurcation has been discovered in 29% of cases of analyzed angiographies i.e. 35% of cases of dissected hearts. We believe that third terminal branch of the left coronary artery should be marked as ramus diagonalis. This branch, including its anastomoses, presents important pattern of the collateral blood flow, which has special meaning, under conditions of coronary insufficiency.

Alma Voljevica, A. Kulenović, Eldan Kapur, I. Vucković

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.

I. Vucković, A. Hadžić, F. Dilberović, A. Kulenović, Z. Mornjaković, I. Zulić, Kucuk-Alija Divanović, Eldan Kapur et al.

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.

In this work we have analyzed 512 coronary angiograms that were done during 2003 year at the Clinic for heart diseases and rheumatism of the University of Sarajevo Clinic Center (UCCS) and we have dissected 20 human hearts at the Institute for Anatomy. We strived to prove frequency of the muscular bridges on branches of the coronary artery, their localization and influence on the arteriosclerotic changes. Using coronary angiography method we consluded that the presence of the muscular bridges in observed population in 4.88% of cases, with the most frequent localization on the anterior interventricular branch (ramus interventricularis anterior). By dissection method the muscular bridges have been found in 55% of cases and the most frequent localization was on the anterior interventricular branch and branches of the right coronary artery. Smaller frequency of the muscular bridges, shown by the angiography method, can be explained by the fact that thick muscular bridges perform weak compression and because of that minimal systolic reduction of the lumen which can not be noticed by the angiography. The muscular bridges are four times frequent on males and they are the most frequent in the age group from 40 to 50 years. In the 88% of patients with the muscular bridges were found arteriosclerotic changes localized proximately from muscular bridge.

In this paper was examined the occurrence frequently more of one kidney artery of the aortic origin. The examinations were performed on the 213 angiograms of the kidney artery by the method of the unselective renal angiography per Seldinger, in both sexes, of the various life ages. On the analyzed angiograms was the presence of these arteries in 25.82% of cases. They were more often at the right side in 49.09%, than on the left side in 36.36%, while their both side presence was found in 14.55%. Although are these arteries more frequently in male persons, a though the sex cannot be statistically significant the parameter for the determination the frequency of their occurrence. In the relation to the backbone column the level of the exit of this arteries from the aorta is the greatest number of cases between the trunk of the first and third loins vertebra (L1-L3) and all were directed according to the medial edge of the corresponding kidney. According the place of the entrance in the kidney can be differed three types of these arteries: the artery, and upper and low polar artery. On the analyzed angiograms most often were found the hilar and lower polar artery, while the upper polar artery was present in only seven cases of the total number of the analyzed angiograms. We consider that the recognition of the supernumerary arteries of the kidney there is both anatomically and the significance in the surgical and radiological practice and their best identification achieves by the application of the angiographic radiology methods.

Alma Voljevica, A. Kulenović, Eldan Kapur, Elvira Talović, I. Vucković, Almira Luinovic

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.

I. Vucković, F. Dilberović, Eldan Kapur, Alma Voljevica, N. Bilalović, I. Selak

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.

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.

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