Morphological and morphometric analysis of the shape, position, number and size of mental foramen on human mandibles.

OBJECTIVE: To provide anatomical information on the position, morphological variations and incidence of mental foramen (MF) and accessory mental foramen (AMF) as they are important for dental surgeons, anesthetists in nerve block and surgical procedures, to avoid injury to the neurovascular bundle in the mental foramen area. METHODS: Our study was conducted on 150 adult dry human mandibles from the osteological collection of the Department of Anatomy of the Faculty of Medicine, University of Sarajevo. The location and shape of the MF and the presence of the AMF were studied by visual examination. The size and position of the MF were measured using a digital vernier caliper. SPSS, version 17 software was used for the statistical analysis. RESULTS: Bilateral mental foramina were presented in all 150 mandibles. In the majority of mandibles, the MF was located between the first and second premolar (20.3%) or on the level of the root of the second premolar (60.3%), midway between the inferior margin and the alveolar margin of the mandible. Most of the mental foramina were oval in shape (83.3%). An AMF was present in four mandibles (2.7%) on the right side. CONCLUSION: This study may be a very useful new supplement to data on variations in the incidence, position, shape and size of mental and accessory mental foramina, which may help surgeons, anaesthetists, neurosurgeons and dentists in carrying out surgical procedures successfully.

Prognostic value of anatomical dominance of coronary circulation in patients with surgical myocardial revascularization.

INTRODUCTION: This study evaluated the frequency of domination of the coronary arteries types in patients treated by surgical myocardial revascularization. The aim of the study was to determine whether the left coronary circulation dominance is a prognostic factor for poorer outcome in patients undergoing coronary artery bypass surgery. MATERIAL AND METHODS: A total sample consisted of 100 patients with coronary artery disease that were treated with coronary artery bypass grafting at the Clinic for Cardiac Surgery, Clinical Center of the University of Sarajevo. To all patients on the basis of preoperative coronary angiography was determined the dominance of the coronary arteries. Patients included in the study were divided into two groups, with the left and right with coronary dominance. RESULTS: Left coronary dominance in a sample of patients was present in 21/100 (21%), right in 69/100 (69%) and balanced in 10/100 (10%) cases. Female gender was significantly more frequent in patients with left coronary dominance and proved to be a stronger predictor of poorer outcome, especially in combination with left main stenosis of the left coronary artery and left coronary dominance. Inability of revascularization of the r. interventricularis posterior (RIVP) was statistically significantly higher in case of left dominance 9/21 (42.9%), compared to the right 16/79 (20.3%), p=0.033. Lethal outcome was more common in case of left dominance in relation to the right (9.4% vs 0.9%). The incidence of surgical complications, respiratory, neurological and renal complications was not significantly different between groups, while the length of hospital stay was significantly higher in the group of patients with left dominance, p = 0.003. CONCLUSION: Left coronary dominance is an important risk factor for patients undergoing surgical myocardial revascularization.

Improvement of ejection fraction after coronary artery bypass grafting surgery in patients with impaired left ventricular function.

OBJECTIVES: The present study evaluates our experience with aorto-coronary bypass grafting in patients with severe dysfunction of left ventricle (LV) and low ejection fraction-EF(<35%). Revascularization of myocardium in this settings remains contraversial because of concerns over morbidity, mortality and quality of life. MATERIAL AND METHODES: Forty patients with severe coronary artery disease and dysfunction of LV (low ejection fraction <35%) underwent coronary artery bypass grafting in period of 3 years. Preoperative diagnostic of 40 patients was consisted of anamnesis, clinical exam, non-invasive methods EHO, MR and invasive diagnostic methods-cateterization. The major indication for surgery was severe anginal pain, heart failure symptoms and low ejection fraction. Internal mammary artery was used in all operated patients. RESULTS: Average age of patients who have been operated was 59,8. In the present study, 81,3% were male and 18,8% female. We found one-vessel disease present in 2,5% (1/40) of patients, two -vessel disease in 40% (16/40), three-vessel disease in 42,5% (17/40) and four -vessel disease in 15% (6/40) of patients. One bypass grafting we implanted in 2,5% patients, two bypasses in 42,5%, three bypasses in 45 5%, and four bypasses in 10% of patients. Left ventricular ejection fraction assessed preoperativly was 18%-27% and postoperatively was improved to 31, 08% in period of 30 days. CONCLUSION: In patients with left ventricular dysfunction, coronary artery bypass grafting can be performed safely with improvement in quality of life and in left ventricular ejection fraction.

Tuberculosis related stigma and delay in seeking care after the onset of symptoms associated with tuberculosis.

AIM: To determine association between tuberculosis (TB) related stigma and delay in seeking a treatment after the onset of symptoms associated with tuberculosis. METHODS: This prospective study was carried out in the "Podhrastovi" University Clinic of Lung Diseases and Tuberculosis and Health facilities for lung diseases and tuberculosis in the Sarajevo area. The sample consisted of 300 tuberculosis patients. Between patients who consider TB a stigmatizing disease and patients who did not consider TB a stigmatizing disease distribution of patient delay was compared. RESULTS: Of the total of 300 patients 79 (26.3%) considered TB a socially stigmatizing disease. Among them 43 (54.4%) were females and 36 (45.6%) males. Among patients in the age group 18-24 years, nine (50%) considered TB a socially stigmatizing disease compared to seven (12.3%) among patients in the age group 65-75 years. Among patients with university degree, nine (64.3%) and among patients that had no education, one (9.1%) declared TB as a socially stigmatizing disease. The average time interval from the appearance of first symptoms of tuberculosis until the first visit to a health care facility for those who consider TB a stigmatizing disease was 6.41 weeks and for those who did not consider it a stigmatizing disease the average time interval was 4.99 weeks. CONCLUSION: Study results revealed high stigma-generating attitudes towards tuberculosis. Perceived TB related stigma had no strong impact on patient delay in seeking care for TB symptoms.

Collateral function in patients with coronary occlusion evaluated by 201 thallium scintigraphy.

The present study evaluated the impact of the angiographically documented collaterals on regional myocardial perfusion measured by 201thallium scintigraphy in patients with a chronic total occlusion. The study included 60 patients with chronic total occlusion who underwent rest-stress myocardial perfusion scintigraphy and coronary angiography. All patients had angiographic evidence of coronary collaterals. Patients were divided into two groups: group one had well-developed coronary collateral vessels (n=35) and group II had poor coronary collateral development (n=25). Patients with chronic total occlusion had severe and extensive stress-induced myocardial perfusion defects regardless of the grade of angiographic coronary collaterals. The perfusion defects in the group with good collaterals were predominantly reversible, suggesting that coronary collaterals preserved myocardial viability in the regions subtended by a total coronary occlusion. A significant correlation between good collaterals with complete protection and poor collaterals with no protection was noted. Our results demonstrate a protective effect of collaterals on myocardial perfusion during coronary occlusion. The effective angiographic collaterals may prevent resting regional wall motion abnormalities but do not appear to protect against stress-induced perfusion defect.

The role of collateral circulation in preserving myocardial function.

The coronary collateral circulation is an alternative source of blood supply to the myocardium jeopardized by the failure of the original stenotic or occluded vessel to provide adequate blood flow to this region. One hundred coronary angiograms and left ventriculograms of patients with coronary artery disease from the Cardiology Department of University Clinics Centre in Sarajevo were reviewed. The role of collateral circulation in preserving myocardial function was assessed by comparing regional left ventricular contractility in 34 instances of total arterial occlusion and adequate colateral circulation with that in 34 instances of total arterial occlusion and inadequate collateral circulation. Among the group with adequate collaterals, regional left ventricular contraction was normal in 41%, hypokinetic in 53% and akinetic or dyskinetic in only 5%. Among the group with inadequate collaterals, regional contraction was normal in 9%, hypokinetic in 20 % and akinetic or dyskinetic in 70%. These data indicate that collateral circulation plays an important role in preserving myocardial contractility in patients with coronary artery disease.

Morphologic findings of the ischemic myocardium.

This study assesses the relation between qualitative and quantitative findings of myocytes and interstitial connective tissue in the ischemic heart disease. Qualitative and quantitative changes of myocytes and interstitial connective tissue were studied on the serial cross myocardial sections from 20 autopsied hearts with ischemic lesions, stained by immunohistochemistry using a monoclonal antibody (von Willebrand factor) and with hematoxylin-eosin method. Myocardial sections included proximal and distal part of occlusion and area of occlusion of coronary vessels. The volume densities (V V) of the cardiac myocytes and interstitial fibrosis in the group with coronary occlusion were examined stereologically and compared with control group. The findings showed a significant reduction in the volume density of myocytes and an increase in the volume density of interstitial fibrosis in patients with coronary occlusion compared with control group. Significant reduction in the volume density of myocytes and an increase in volume density of interstitial fibrosis were greater in the distal part of occlusion and area of occlusion, than in the proximal part of the occlusion. Our stereological results give useful quantitative information's of changes in myocardium parts during coronary occlusion as well as in normal conditions, and represent objective proof of significant changes in ischemic myocardium described by qualitative analyses.

Branching of main trunk of left coronary artery and importance of her diagonal branch in cases of coronary insufficiency.

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.

Collateral circulation in human heart.

The aim of the investigations was to demonstrate different types of collaterals of coronary arteries using the method of coronary angiography and injection-corrosion method. The investigations were carried out on 30 human cadaveric hearts from the Department of Anatomy, and 30 angiograms of patients from the Cardiology Department of Clinics Centre in Sarajevo. Clinical investigations were retrospective and prospective on patients that were treated in hospital, and on patients that just arrived in hospital (based on findings of coronary angiography). The results show the existence of different types of collaterals: intercoronary and intracoronary. We established collaterals in a case with occlusion of the right coronary artery and left coronary artery in which better development of collaterals was established. Our patients were classified in two groups: 1) Patients with good collaterals and good left ventricular function; 2) Patients with good collaterals and impaired left ventricular function. On the anatomical material we found different types of collaterals as well. Our results show that coronary angiography is useful diagnostic method for the demonstration of coronary collaterals.

Anatomical-clinical investigations of variations of the human coronary arteries.

Variations of the human coronary arteries have always attracted the attention of many researchers. A review of the literature shows that variations can cause ischemic heart disease or sudden cardiac death. The aim of the investigations was to examine the existence and clinical significance of variations of the human coronary arteries. Special attention has been focused on myocardial bridging of the coronary arteries and coronary arteriovenous fistula. Our investigations were carried out on the human hearts at the Department of Anatomy and on patients at the Cardiology Department of University Clinical Centre in Sarajevo. Using the method of dissection and coronary angiography we established the existence of variations of the coronary arteries (variations of origin, distribution) on the human hearts without macroscopic visible changes as well as on patients with ischemic changes (angina pectoris, myocardial infarction, congenital cardiovascular malformation etc.). We established the higher incidence of ischemic changes on patients with variations of coronary arteries.

[Intramural blood vessels in the AV segment of the human heart conduction system]. / Intramuralni krvni sudovi A-V segmenta provodnog sistema u covjecijem srcu.

We have investigated the intramural blood vessels of the A-V segment in the conductive system of 20 human hearts using the method of light microscopy. The results of our study have shown that the A-V segment of the conductive heart muscles in human hearts has an abundant vascularisation. We have found the greatest density of the intramural net in the dorsal part of the A-V node; this density of blood vessels decreased toward the Hiss' bundle. After comparing these results with the earlier findings in the study of the intramural net in the S-A system we have found that A-V segment of the conductive heart system has a poorer blood supply in regard to S-A system. We have also found that the intramural net of blood vessels is weaker in the adjacent ventricular parts and in the interventricular septum. It cannot be said that there exists any surface vascular zone subepicardial, middle and deep sub-endocardiac--in the A-V segment of the conductive system of human heart.