The Radiologist Workload Increase; Where Is the Limit?: Mini Review and Case Study.

INTRODUCTION: Radiologist workload had increased significantly within the past three decades. In 2006-2007, the average annual workload per FTE radiologist was 14,900 procedures, an increase of 7% since 2002-2003 and 34.0% since 1991-1992. Annual RVUs per FTE radiologist were 10 200, an increase of 10% since 2002-2003 and 70.3% since 1991-1992. SUBJECTS AND METHODS: The study included worksheets data of three radiology specialists in their first three years as specialists. Data were collected and analyzed retrospectively for the period frame January 1st to September 21st 2018. The total data of imaging procedures by one radiologist had been collected and then separated by different imaging procedures as followed. RESULTS: Average total number of imaging procedures per radiologist was 2785. Separately, there were: 850 bone X ray images, 550 chest X rays, 250 ultrasound examinations, 860 CTs and 256 MRIs. Daily average of analyzed imaging procedures per radiologist was as followed: 7.4 bone X ray images, 4.8 chest X rays, 2.2 ultrasounds, 7.5 CTs and 2.2 MRIs. Total working time per radiologist in the analyzed time period was 684 hours. Average time spent for analyzing per one imaging procedure was 14 minutes and 45 seconds spread in total 114 working days. CONCLUSIONS: The conclusion is that current workload for a radiology specialist obviously represents a necessity to be thoroughly explored. This case study and previous literature results indicate that a well constructed large scale study represents a potential in resolving the previous studies limitations and providing relevant data, so correct measures and guidelines could be developed.

The Positive Effects of Running on Mental Health.

Working as a team with patients who are also recreational runners and managing a running school in the City of Mostar had made us thinking on how recreational running affects the mental health in individuals. Previous literature is pretty old dated, so we found this even more interesting. We have wondered why there is no more recent literature on this subject. So, while working on this mini review and discussing on this subjects we came up with an idea on a research about self esteem and life quality of individuals pre and post running school experience. Previous studies show that consistent running results in a number of positive psychological changes among diverse populations. In a study of Kenneth E.C. ordinary nonprofessional runners were surveyed about the psychological aspects of running. Many of the respondents had started running to improve their health, and almost all noted mental and emotional benefits including relief of tension, improved self-image, and better mood. Considering therapeutic effects of running Greist et al. define running as not expensive, and unlike sorne other treatments, it has beneficiai physical side effects. Their results compare favorably with those of patients in psychotherapy and have persisted for at !east one year in follow-up. Taking in mind all of the previously published research it can be concluded that running can be a therapeutic tool for a sereies of negative psychological conditions, such ass depression, anxieta, tension, mood changes, low self esteem etc. Although, these research are a few decades old there is still no recipe or dosage for running, especially in the area of physical ilness prevention. There is much to research and to be discovered in this field.

Addictions without Drugs: Contemporary Addictions or Way of Life?

In the five thousand years of recorded history there is written evidence of various types of addiction. In recent decades scientists focus their attention on addictions without the immediate introduction of psychoactive substances into the organism or the so-called "addictions without drugs". Studies have revealed a number of similarities between drug addictions and addictions without drugs that also carry biological, psychological and social consequences in the form of addictive activity carvings, adrenaline alarm, dopamine and serotonin secretion, tolerance and abstinence syndrome same as classical forms of addiction. Although the physiological effect of addiction without drugs on the brain and nervous system is not yet sufficiently explored, scientists have found equivalent effects on addicts suffering from one or the other type of addiction. These addicts are almost generally dysfunctional persons who become prisoners of their own passions, and the consequences are numerous technological advantages offered by modern times and in some respects a punishment due to the civilization for forgetting the man himself. Considering that most people, so and many psychiatrist, often accept these addictions as a lifestyle and without any delay and awareness of the potential dangers they may pose, we can with certainty say that the so-called "addictions without drugs" are the scourge of the 21st century. With pathological gambling, which is as old as human civilization, in recent decades we meet the growing problems of internet addiction, gambling games, which are classified for the first time at DSM V in addictive disorder, uncontrolled shopping, food cravings, addiction to sex, weight loss, sports, work and many more, which are mostly true addictions, and not only the way of life. The aim of this paper is to point to the growing problem of addiction without drugs, which is becoming an increasing problem within our community.

Level of Education as a Risk Factor for Extensive Prevalence of Cervical Intervertebral Disc Degenerative Changes and Chronic Neck Pain.

OBJECTIVE: The aim of this study was to document the prevalence of degenerative intervertebral disc changes in the patients who previously reported symptoms of neck pain and to determine the influence of education level on degenerative intervertebral disc changes and subsequent chronic neck pain. METHODS: One hundred and twelve patients were randomly selected from the University Hospital in Mostar, Bosna and Herzegovina, (aged 48.5±12.7 years) and submitted to magnetic resonance imaging (MRI) of the cervical spine. MRI of 3.0 T (Siemens, Skyrim, Erlangen, Germany) was used to obtain cervical spine images. Patients were separated into two groups based on their education level: low education level (LLE) and high education level (HLE). Pfirrmann classification was used to document intervertebral disc degeneration, while self-reported chronic neck pain was evaluated using the previously validated Oswestry questionnaire. RESULTS: The entire logistic regression model containing all predictors was statistically significant, (χ2(3)=12.2, p=0.02), and was able to distinguish between respondents who had chronic neck pain and vice versa. The model explained between 10.0% (Cox-Snell R2) and 13.8% (Nagelkerke R2) of common variance with Pfirrmann classification, and it had the strength to discriminate and correctly classify 69.6% of patients. The probability of a patient being classified in the high or low group of degenerative disc changes according to the Pfirrmann scale was associated with the education level (Wald test: 5.5, p=0.02). Based on the Pfirrmann assessment scale, the HLE group was significantly different from the LLE group in the degree of degenerative changes of the cervical intervertebral discs (U=1,077.5, p=0.001). CONCLUSION: A moderate level of intervertebral disc degenerative changes (grade II and III) was equally matched among all patients, while the overall results suggest a higher level of education as a risk factor leading to cervical disc degenerative changes, regardless of age differences among respondents.

Prevalence of Coronary artery anomalies detected by Coronary CT Angiography in Canton Sarajevo, Bosnia and Herzegovina.

BACKGROUND: Coronary artery anomalies (CAAs) are congenital variations of one or more of the coronary arteries and they are an uncommon but important cause of chest pain and, in some cases, sudden cardiac death. Anomalies of coronary arteries may be found incidentally in 0.3-1% of healthy individuals. The three types of coronary artery anomalies are anomalies of origin, anomalies of course and anomalies of termination. The purpose of our study was to estimate the frequency of CAAs in Canton Sarajevo, B&H, and to deteremine the prevalence of origin, course and termination anomalies of coronary arteries. SUBJECT AND METHODS: This was a retrospective analysis of 919 patients who underwent Coronary CT Angiography to determine CAAs in the period from 2013 to 2017. RESULTS: In our study, total number of CAAs have been found among the 130 patients (14.12%) out of which anomalies of origin are found at 14 patients (1.52%), anomalies of course at 115 patients (12.5%) and anomaly of termination in 1 patient (0.1%). Out of 14 cases in total anomalies of origin, anomalies of origin of the left coronary artery are observed among 11 patients (1.2%), and anomalies of origin of the right coronary artery among 3 patients (0.3%). From mentioned 14 cases of the anomalous origin of the coronary arteries, anomalies with clinical significance (interarterial, malignant course) of the coronary arteries are found among 6 patients (0.65%) and anomalies without clinical significance are found among 8 patients (0.87%). Coronary artery anomalies of origin with malignant course are devided in two groups: LMA from right sinus of Valsalva with interarterial course observed in 4 patients (0.43%) and RCA from left sinus of Valsalva, also with interarterial course in 2 patients (0.21%). We found 4 patients (0.43%) with separated origin LAD and LCX, without LMA. The preavlence rates of separate origin of RCA and conus artery, anomaly origin of the LCX from right coronary sinus, anomaly origin of the LMA from posterior coronary sinus and LMA from right coronary sinus without interarterial course were seen in 0.1% of patients. Among 115 cases of anomalies of course 111 cases (12.07%) belongs to bridging (37 cases to LAD; 25 cases to D1 and D2 and 49 to ramus intermedius), and 4 cases (0.43%) belongs to intraatrial course of RCA. Anomaly of termination presented with fistula between LCX and coronary sinus was found only in 1 case. CONCLUSION: Coronary CT angiography is an excellent tool for diagnosis of CAAs regarding origin, course and termination of the coronary arteries.

Intercondylar notch width and inner angle of lateral femoral condyle as the risk factors for anterior cruciate ligament injury in female handball players in Herzegovina.

The principal purpose of this prospective study was to examine intercondylar notch size and the value of inner angle of lateral femoral condyle as the risk factors for noncontact anterior cruciate ligament ACL injury and than to correlate them to the physical values of the athletes such as body mass index (BMI), hight, wight, etc. There are indentified two type of risk factors, external include shoes-surface interaction, type of playing surface, weather conditions and internal include anatomic, neuromuscular, biomechanical and hormonal factors that may predispose female athlets to noncontact injury of ACL. Among anatomic factors, intercondylar notch stenosis and larger inner angle of lateral condyle of femur as the factors which can cause impigement of ACL, were related to an increased risk of injury of ACL. In this study were included 51 female athlete. In the study group there were 24 female handball players with ACL tear and in control group there were 27 female handball players without any type of injury of the knee, who are practicing handball on a daily basis for at least for two years. In the first step, were gathered clinical data performed by orthopaedic surgeon. In the second step, the femoral notch width and the inner angle of lateral condyle of femur were measured on coronal MR-images. Study has shown that value of inner angle of lateral condyle of femur was significantly higher in athletes with ACL tear compared to those without. Value of width of intercondylar notch was statisticaly smaller in athletes with ACL tear, compared to those without. In the conclusion the inner angle of lateral femoral condyle is better predicting factor for ACL tear in young female handball players compared to intercondylar notch width.

Chronic synovitis after synovial sarcoma resection: a case report.

We present a diagnostic course and treatment of synovial sarcoma in a young 16-year-old male patient. The clinical course with special emphasis on the imaging techniques is presented here, providing an overview of this subject and offering a useful educative material. The course of the follow-up is also described, largely relying on MRI in diagnosis course. Changes in the synovial tissue of the knee were recorded, later to be classified as the sarcoma. Post-operative course suggested the existence of chronic synovitis. Further studies are needed to fully understand the changes that may affect knee mechanics after surgery and/or inflammation factors secreted by tumor cells.

Giant infrapatellar ganglion cyst of Hoffa's fat pad.

We present the case of a 36-year-old woman who works as a kindergarten teacher, often she is kneeling on her knees due to the nature of the job. Since a year ago, she noticed that her right knee was swelling. She had an orthopaedic examination when she could no longer bend her knee. Inspection and palpation revealed the swelling of the anterior and anterior-lateral aspect of the knee. MRI imaging revealed a large, sharply defined, lobulated lesion of the infrapatellar fat pad. After the surgical incision, a lobular lesion was found and surgically removed. Histological analysis confirmed a ganglion cyst.

Early results of the conservative treatment of distal radius fractures-immobilization of the wrist in dorsal versus palmar flexion.

Aim To evaluate immobilization with dorsal forearm plaster splint with the wrist in dorsal flexion vs palmar flexion in patients with distal radius fracture. Methods In the prospective study (2012-2014) 122 patients (of which 22 patients lost) with fractures of the distal radius type A2, A3 and C according to the AO classification were investigated. At the end there were 50 patients in each of the two groups: the dorsiflexion (DF) group had a total of 37 women and 13 men, mean age was 63.48 ± 14.70, and in the palmar flexion (PF) group there were respectively 38/12, and the mean age was 64.20 ± 12.99. In both groups measurements of radiological, clinical and functional parameters were conducted. Patient related wrist evaluation survey (PRWE) and SF12 questionnaire were used for evaluation of pain and function of the wrist and physical and mental condition, respectively. Results The study showed excellent results in both groups but there was significant improvement in the range of motion (ROM) on every measurement in the DF group: dorsal flexion 47.70±15.29; ulnar deviation 24.10±7.80; radial deviation 11.50±5.65 vs PF 22.80±19.04; 16.00± 9.31; 4.80± 494 (p<0.001). Also, radiological parameters showed significant improvement until the end of the follow-up. Functional parameters showed significant improvement of physical component of SF-12 in the DF group (p<0.014). Conclusion Immobilization with forearm plaster splint on the dorsal side and with the wrist in dorsiflexion gives better early clinical, radiological and functional results in patients with fractures of type A2, A3, C1-3 in patients of all age groups, compared to immobilization with the wrist in palmar flexion.

[Perinatal care in Livno immediately after the war from 1995 to 1999]. / Perinatalna skrb u Livnu u neposrednom poracu 1995.-1999. godine.

The paragraphs of statistics for maternity hospital of county hospital in Livno for period 1995-1999, year are presented and describe perinatal, fetal and early neonatal mortality, newborns to birth-weight, the frequency of caesarean section, eclampsia, vacuum extraction, antenatal care and equipment maternity hospital and morbidity of the infants. Perinatal mortality in 1995 was 5.6@1000, but for 4 years 6.9@1000. Early neonatal mortality was appearing till 1996 year only with one death of newborn (1.1@1000). Fetal mortality was increased to 12.3@1000 in 1997; but the years before was 6.2@1000. According to the weight of newborns, 3.5% were no more than 2.500 g, but 93.5% were between 2.500-3.000 g, while newborns over 4.000 g where 3.0 percent. Watching and closely looking statistics for years in the classified groups does not fortify the major differences, except 1995 when was 1.7% newborns less than 2.500 g, but over 4.000 g 7.9%, that is under average and explaining to the minimum numbers of birth that year, and orienting refugees and exilied pregnant women to the centres with stronger obstetric and neonatal care Eclampsy were 9 and it was 2.2@1000. The number of antenatal visits of pregnant women increase during all these years, so that total number of visits was 20.905, that means 5.2 was the middle number of visits. There are much more without 2.0% or less than 3 visits 5.0%; with 9 or more 29.0%; the average number ultrasound examination is 3.4, and total 13.748, 37.0 percent of pregnant women is with 3 examples and 10.0% with 4 or over it, but 7.0% without ultrasonographc. It is obviously, that the number of the pregnant women without ultrasound examination is falling, so in 1995 there was 14.0% but 2.0% in 1999. Very important is increase those with 3 examination according to 1995 when there was 27.0%, but 47.0% in 1999. The usage of caesarean section is 7.7% but the major increase was in 1998 and it was 9.4% and 1999 is 10.1%. Vacuum extraction was used in 67 (1.7%) of newborns but in 1995 was 3.2%, the obstetric activity does three gynecologists. For perinatal mortality is important to say, that, during the war time, about 6.9@1000 in maternity hospital Livno was ranged into the group with low perinatal mortality. According to, the number of vacuum extraction belongs to the number of maternity hospital with vacuum extractions below 2.0%. Maternity hospital has two incubator after 1997 year and cardiotocographic intrapartal monitoring was used in about 55-65% of all deliveries.