Radiological evaluation of lumbosacral spine for post discectomy segmental instability.

Aim To establish presence of segmental instability in patients operated with standard discectomy comparing measurement of translation and rotation on postoperative functional radiographs of lumbosacral spine with reference values,and to explore difference between patients operated on one or two levels. Methods The study included 71 patients, who were operated due to herniated lumbar disc. They were divided into two groups operated on one level (group A) or two adjacent levels (group B). All patients had been imaged in a standing position with functional lateral radiography. Radiographic images were digitized and then computerized measurement of translation and rotation was made. Measurement data were compared between the groups and with reference values obtained in healthy adults. Results Standard lumbar discectomy leads to an increase in translation, however, it reached statistical significance only for L4/L5 level and a decrease of rotation, which showed statistical significance for all samples, relative to the reference values. There was no statistically significant difference in the values of translation and rotation between the groups for corresponding levels, except for the value of the rotation for L4/L5 level as adjacent, unoperated level. Comparison of translation and rotation between the operated and adjacent levels did not show a statistically significant difference. When it comes to comparing the measured and predicted translation, there was a statistically significant difference only at the L5/S1 as anunoperated level. Conclusion Standard discectomy does not lead to radiologically significant segmental instability, and two-level surgery has not caused more pronounced signs of instability comparing to onelevel surgery.

Vascular geometry of vertebrobasilar tree with and without aneurysm.

AIM: To examine a possible relationship between the variable vascular geometry of vertebrobasilar joint angle and basilar bifurcation angle as well as the diameters of these blood vessels. METHODS: The study included 60 adult patients, of both sexes, who were divided into two groups. One group (30) consisted of patients without aneurysm of vertebrobasilar tree, and another group (30) of patients with aneurysm. The patients were examined using Magnetic Resonance Imaging (MRI) and Computed Tomography Angiography (CTA) of head and neck. RESULTS: In the group without aneurysm of vertebrobasilar tree, in 14 (46.6%) patients diameters of the right and the left vertebral artery were approximately the same. The average value of the angle of junctions of vertebral arteries was 65.43°, and the average angle of basilar bifurcation was around 94.53°. In the group with aneurysm of vertebrobasilar tree, in 12 (40%) patients diameters of the right and the left vertebral artery were also approximately the same. The average angle of junction of vertebral arteries was 68.46º, and the average angle of basilar bifurcation was 121.93º. CONCLUSION: Anatomic variations of the vertebrobasilar joint angle and basilar bifurcation angle, as well as the diameters of these blood vessels, are some of the factors in the increase of the incidence of aneurysm in this anatomic area.

Variations in diameters of vertebro-basilar tree in patients with or with no aneurysm.

INTRODUCTION: The morphological anatomy of the posterior circulation is very complex and variable. Aims of this research were to document the morphological anatomy of the posterior circulation along with variations in the Bosnian population, in patients with or without aneurysm. Measurements of the outer diameters of the vertebral artery, basilar artery and posterior cerebral artery were taken. The second aim was to determine the possible relationship between diameters of the area with subsequent aneurysm formation. MATERIAL AND METHODS: The study involved 60 consecutive patients, adults of both sexes, treated in the UKC Tuzla. The patients were divided into two groups. One group consisted of the patients without aneurysm of basilar artery, and the other group of patients with aneurysm. All the 60 patients were treated by means of MRI angiography. RESULTS: The mean diameter of the vertebral artery was 2.43 mm; 3.61 mm on the right and 2.83 mm; 3.94 mm on the left. The diameter of the basilar artery varied from 3.8 mm; 3.43 mm. The diameter of the posterior cerebral arteries 2.5 mm; 2.52 mm on the right and 2.46 mm; 2.62 mm on the left. CONCLUSIONS: We have documented the various morphometry variations as well as the differences of the anatomy in this area in Bosnian population as compared to the medicine literature.

Intrahepatic transposition of bile ducts.

Objective. To describe the intrahepatic bile duct transposition (anatomical variation occurring in intrahepatic ducts) and to determine the frequency of this variation. Material and Methods. The researches were performed randomly on 100 livers of adults, both sexes. Main research methods were anatomical macrodissection. As a criterion for determination of variations in some parts of bile tree, we used the classification of Segmentatio hepatis according to Couinaud (1957) according to Terminologia Anatomica, Thieme Stuugart: Federative Committee on Anatomical Terminology, 1988. Results. Intrahepatic transposition of bile ducts was found in two cases (2%), out of total examined cases (100): right-left transposition (right segmental bile duct, originating from the segment VIII, joins the left liver duct-ductus hepaticus sinister) and left-right intrahepatic transposition (left segmental bile duct originating from the segment IV ends in right liver duct-ductus hepaticus dexter). Conclusion. Safety and success in liver transplantation to great extent depends on knowledge of anatomy and some common embryological anomalies in bile tree. Variations in bile tree were found in 24-43% of cases, out of which 1-22% are the variations of intrahepatic bile ducts. Therefore, good knowledge on ductal anatomy enables good planning, safe performance of therapeutic and operative procedures, and decreases the risk of intraoperative and postoperative complications.

Frequency of superficial and deep vein thrombosis in patients with variations of superficial veins of lower extremities.

UNLABELLED: Anatomical variations of veins often play a crucial role in formation of thrombotic changes in superficial and deep veins of lower extremities. THE AIM of this study was to determine the frequency of the dominant type of the lower extremity superficial veins, and to determine the eventual influence of such variations to the formation of superficial and deep vein thrombosis (DVT). MATERIAL AND METHODS: The sample used in this study consisted of 180 patients subjected to ascedent contrast phlebography of lower extremities. The total sample was divided into following groups: patients with and without variations of the lower extremity superficial veins. RESULTS AND DISCUSSION: Dominant type of the superficial veins (without variation) consisted of 97 patients (53.89%), while the rest of 83 patients showed some kind of anatomical variation (46.11%). The most frequent variation was the duplicated form ofv. saphena magna in 53.85%, while this procentage in women was 57.89%. Most frequent variations of duplicated v. saphena magna were: simple duplicated form, closed loop form, branching form and combined form. Topographical variation of saphenopopliteal junction besides fossa poplitea in the group of men showed procentage of 53.85%, while in the group of women that value accounted 63.16%. CONCLUSION: The percentage of varicose veins was more frequent in men and women without variations, but deep vein DVT showed higher frequency in patients with anatomical variations of superficial veins of lower extremities.

Morphometric changes of the lumbar intervertebral space following discectomy on one or two levels.

AIM: To investigate a potential difference in postoperative morphological changes of two-level lumbar disc surgery as compared to one level surgery. METHODS: The standard lateral radiographs of lumbar spine obtained preoperatively and postoperatively were used in the study . The morphological study included 60 adult patients of both sexes who had undergone the surgery in the period 2002-2006. The first group comprised patients operated on one level (L4/L5 and L5/ S1), and the second included patients operated on two levels (L3/ L4/L5; L4/L5/S1 and L5/S1/S2). Using lateral radiographs, after digitalization, the height of intervertebral disc space (HD), angle between vertebral bodies (A) and translation (T) were measured. RESULTS: Comparing preoperative and postoperative values, statistically significant difference has been found for HD in the first group and HD and A in the second group. In neither groups there was statistically significant difference for T, which is one of radiological signs of segmental instability. The comparison of postoperative values for both groups has not shown any statistically significant difference. CONCLUSIONS: The standard lumbar discectomy on two levels has not shown more pronounced morphological changes or changes suggesting an increased risk of segmental instability as compared to one level discectomy.

Effectiveness of treating the renal anemia in chronic hemodialyzed patients by epoietin alpha and beta.

INTRODUCTION: Anemia is an early sign of chronic kidney dysfunction, caused by many different factors, but the insufficient erythropoietin synthesis is the crucial factor in its development. OBJECTIVES: The objective of our study was to compare effectiveness of epoietin alpha and beta application in the treatment of renal anemia in chronic hemodialyzed patients. PATIENTS AND METHODS: The group included 60 patients of both sexes, randomly chosen. Criteria for including patients into the study were: older than 18 years, haemodialyzed longer than three months and treated by epoietin beta, stable level of hemoglobin, between 9 and 11 g/dL at least two successive measurements and no malignant disease present. The patients were then randomized into groups: 20 patients were administered epoietin alpha intravenously instead of epoietin beta subcutaneously (experimental group); 20 patients were administered intravenously epoietin beta instead of epoietin beta subcutaneously (control group A), the rest of 20 patients were administered epoietin beta subcutaneously (control group B). All the testees were administered epoietin alpha or beta three times weekly after haemodialysis, intravenously or subcutaneously. RESULTS: Comparison among mean values of hematological and biochemical parameters before starting the treatment by erythropoietin, and third and sixth months after therapy in the studied groups, no significant difference was found (p > 0.05). CONCLUSION: Epoietin alpha and beta showed approximate degree of efficacy in renal anemia treatment of hemodialysis patients. The way of erythropoetin administration did not significantly effect the level of hemoglobin and hematocrit in six months research period.

Nucleotides affect neurogenesis and dopaminergic differentiation of mouse fetal midbrain-derived neural precursor cells.

The fetal midbrain is a preferred source for isolating and producing dopaminergic neurons for subsequent grafting and replacement of damaged or lost dopaminergic midbrain neurons. We analysed the potential of a variety of nucleotides and of adenosine to support dopaminergic neuron formation from primary mouse fetal midbrain-derived cells, harvested at E10.5 and at E13.5 and subjected to adherent cell culture. In contrast to cells derived at E13.5, cells derived at E10.5 have the potential to produce dopaminergic neurons in culture. These neurons express tyrosine hydroxylase and the dopamine transporter. The fetal ventral midbrain contained mRNA encoding almost all P2X and P2Y receptors, all adenosine receptors as well as the ectonucleotidases nucleoside triphosphate diphosphohydrolase 2 and tissue nonspecific alkaline phosphatase. Essentially, all components of the purinergic signalling pathway were also expressed by the cultured cells. ATP, ADPßS, 2MeSATP, 2ClATP and adenosine increased neuron formation. There was, however, no preference for the formation of dopaminergic neurons-with the exception of 2ClATP that increased the relative contribution of tyrosine hydroxylase-positive neurons. In cells isolated at E13.5 UTP promoted neuron survival but ADPßS and ATPγS essentially eliminated neurons. These data showed that the outcome of nucleotide application was different even though cells isolated at E10.5 and E13.5 expressed very similar receptor mRNA profiles. They suggest that purinergic agonists carry potential for stimulating neurogenesis and enriching the contribution of dopaminergic neurons in vitro. Nucleotide receptor agonists may be of value for contributing to the formation and survival of dopaminergic neurons in vivo.

[Variations in position and place of formation of appendix vermiformis found in the course of open appendectomy]. / Varijacije polozaja i mjesta nastanka appendix vermiformis utvrdene tokom klasicne apendektomije.

This paper describes variations of the appendix vermiformis, found in the course of open appendectomy. Investigations involved surgeries performed in 2008 year in the Regional Hospital TeSanj. Variations in the site of formation and position of appendix vermiformis were established. Dominantly, appendix vermiformis is placed in the pelvic position in 57.71% of cases. In the smallest number of cases (2), or 3.07% lateral (paracecal) position was found. Variations of position of ostium appendicis vermiformis were registered as well. Two types of ostium appendicis vermiformis were found: dorso-medial wall of intestinum caecum below ostium ileocaecale (35.39%), dorso-lateral medial wall of intestinum caecum (30.7%) and lower pole of intestinum caecum (64.61%). Results of this research indicate very large variability of appendix vermiformis anatomy, which together with other factors (age, sex, phase in which is patient at the moment of examination) form a clinical picture of the acute appendicitis.

Disorders of hemostasis in the course and after laparoscopic cholecystectomy.

INTRODUCTION: Hemostasis is a very important mechanism, whose changes can cause different complications. In the course of surgical interventions some changes in the system of coagulation happen. Laparoscopic cholecystectomy is a method of choice in the treatment of gallbladder calculosis. In the course of the procedure, parameters of hemostasis change, which stimulates a possible appearance of thromboembolic complications. The objective of our research was to reveal the changes in the system of coagulation in patients treated by laparoscopic cholecystectomy. EXAMINEES AND METHODS: Total sample involved 60 patients, divided into two groups, who were treated either by classical or laparoscopic method. Parameters of primary and secondary hemostasis were determined for the patients of both groups in Polyclinic for Transfusiology UKC Tuzla, before the operation, in the course, and 24 hours after the operation, and on the 5th day after the surgery. RESULTS: Patients from both groups showed changes in the process of coagulation. The changes were more expressed in the group of patients treated by laparoscopic cholecystectomy. Very important result was the increased value of D-dimer measured on the 5th day after the operation in the patients operated by laparoscopic cholecystectomy, where value was 2.5 times higher in the relation to preoperative value (263.5 microg/l, so it was out of referential value). Increase of fibrinogen in both groups were an important result of this study. DISCUSSION AND CONCLUSION: Results of the study showed changes in the process of coagulation in both groups, and increased fibrinolytic activity of the organism after laparoscopic cholecystectomy (requires a discussion on longer and thorough prophylaxis of tromboembolism).

[Anatomical variations of roots of the common bile duct]. / Anatomske varijacije korijenova ductus hepaticus communis.

Variations of extrahepatic bile ducts are the basis of hepatobilliar surgery, and they may be a problem during the surgical procedures. In this paper we present the results of our research, wich is conducted on 100 human livers. Common hepatic duct wich is formed by connecting of right hepatic duct and left hepatic duct is noticed in 92% of cases, and in 5% of cases was formed by tree bile ducts. Aberant bile ducts was found in 3% of total number of examined.

Martin-Gruber anastomosis and transposition in cubital tunnel.

This describes the indivisible anastomosis of the main stem of median nerve with ulnar nerve through cubital tunnel followed by the anomaly of ulnar artery that appears as superficial ulnar artery. Both anomalies are found during the anatomical dissection of a grown-up male cadaver, on his right arm. Such case is very rare as, in the literature available to us, it has not been described.

Ecto-nucleotidases, molecular properties and functional impact

Las ecto-nucleotidasas hidrolizan los nucleótidos extracelulares. Los nucleótidos se encuentran entre las sustancias mensajeras más ubicuas en vertebrados. Los receptores de nucleótidos se expresan en la superficie de prácticamente todas las células y muchas células expresan varios tipos de estos receptores. Se han identificado varias familias de ecto-nucleotidasas, las cuales difieren en su distribución tisular y en sus propiedades funcionales. Modulan la disponibilidad del ligando en los receptores de nucleótidos y de adenosina. Las ecto-nucleotidasas fueron identificadas por primera vez en la década de 1940. Los trabajos de las dos últimas décadas han mostrado sus características moleculares así como importantes propiedades funcionales. Utilizando delecciones génicas dirigidas se han mostrado claros ejemplos destacables de la importancia de las ecto-nucleotidasas en la señalización por nucléotidos y adenosina. Estos ejemplos abarcan desde el control del flujo sanguíneo y la angiogénesis a la modulación de las funciones inmunes y el desarrollo nervioso. Ecto-nucleotidasas específicas están asociadas con células madre en el cerebro adulto de mamífero, implicando un papel de los nucleótidos y nucleósidos en el control de la neurogénesis adulta. Las ecto-nucleotidasas representan importantes dianas terapéuticas para interferir en las vías de señalización mediadas por receptores P2 o P1. El desarrollo de ensayos de alto rendimiento promete una considerable aceleración en el desarrollo de inhibidores de subtipos específicos de ecto-nucleotidasas

Ecto-nucleotidases hydrolyze extracellular nucleotides. Nucleotides are amongst the most ubiquitous messenger substances in the vertebrate body. Receptors for nucleotides are expressed on the surface of essentially every cell and many cells carry several types of nucleotide receptors. Several families of ecto-nucleotidases have been identified that differ in tissue distribution and functional properties. They modulate ligand availability at nucleotide and adenosine receptors. Ectonucleotidases were first identified in the 1940ies. Work of the past two decades has unraveled molecular identities and important functional properties. Using targeted gene deletion clear examples highlighting the importance of ecto-nucleotidases in nucleotide and adenosine signaling have been elaborated. These reach from the control of blood flow and angiogenesis to the modulation of immune functions and neural development. Specific ecto-nucleotidases are associated with stem cells in the adult mammalian brain, implicating a role of nucleotides and nucleosides in the control of adult neurogenesis. Ecto-nucleotidases represent important therapeutic targets to interfere with P2 or P1 receptor-mediated receptor signaling pathways. The development of high throughput assays promises a considerable acceleration in the development of subtype-specific ecto-nucleotidase inhibitors

[Variable anatomy of the kidneys--relationship and incidence between anatomical and clinical three-dimensional image methods]. / Varijabilna anatomija bubrega--odnosi i incidenca na anatomskim i klinickim trodimenzionalnim "image" metodama.

UNLABELLED: Research has been done at a 150 pairs of the human adult kidneys (50 anatomical preparedness plus 100 patients) both sex, randomly chosen. Variations of the kidneys have been analyzed and their respect at a live ones, by clinical tree-dimensional "image"methods and lifeless one by anatomical macro dissection plus corrosive method. CONCLUSION: At the most presence of noticed variation had into a size of the kidney, and the lowest one in the number of the kidneys. Technique of magnetic resonance (MR), in relation with computerized tomography (CT) had shown more types of the kidneys variations and more number of the kidney's variations in the form. Percentage of variations of the kidneys at an anatomical preparedness in relation with variations noticed by MR and CT, into a size had relation 44: 4: 0, in the form of 36: 6: 2, in the number 0: 2: 0 and into a location ( rotation) 0: 0: 4. The number and the type of noticed variations of the kidneys show the largest presence at an anatomical matiarials assigned by anatomical macro dissection and corrosive technique in relation with noticed variations of the kidneys by MR and CT. Because of that anatomy finding are set as an imperative into methodological researches of variable anatomy of the kidneys.

[Aberrant and accessory bile ducts]. / Aberantni i akcesorni zucni vodovi.

In this work the frequency of aberrant and accessory bile ducts on anatomical preparations and clinical radiograms was researched. Aberrant bile ducts were detected in 2.5%.

[Anatomic variations of the cystic duct and its junction with the common hepatic duct]. / Anatomske varijacije ductus cysticus-a i njegovog spoja sa ductus hepaticus communis.

The ductus cysticus is variable in the length, position and the site where it enters the ductus hepaticus communis--the cystohepatic junction. The investigations were carried out on 100 livers (50 anatomical preparations and 50 patients) adults of both sexes, randomized trial. Main methods of the research were: anatomical macrodissection and analysis of the clinical radiograms. The ductus cysticus were present as: flat--down course in 70%, flat--horizontal course in 2%, flat--ascendant course in 4%, curved in the shape "J" in 10%, curved in the shape "S" in 12% and curved in the shape "U" in 2%. The cystohepatic junction shows variations in topographic zones.

The ventilatory patterns of the left upper lobe of lung.

Having knowledge on models of the bronchial tree branching, is of a special interest for clinical and surgical pulmology, because the hemilobectomy, segmentectomy and subsegmentectomy are always determined by intralobar, intrasegmental and intrasubsegmental bronchial ramification. Investigations were performed on 100 lungs of children and adults of both sexes, one day to 85 years old, randomly chosen. There are two main types of branching of the left upper lobe bronchus: the bifurcation pattern as dominant model in 74% and the trifurcation model found in 26%. Out of 100 lungs studied, 21 lungs had the ventilatory variations of the bronchopulmonary segments. The classification and categorization of the ventilatory of bronchopulmonary segments of the left upper lobe of lung were made. This classification contains 5 categories and 8 subcategories.

[Variations in the position and point of origin of the vermiform appendix]. / Varijacije u polozaju i mjestu nastanka appendix vermiformis.

There were investigated variations of appendix vermiformis in the place of origin and position. The investigations were carried out on 50 human preparations of adults of both sexes, unintentional choice. The position and relation between intestinum caecum and appendix vermiformis were determined by forensic medical and pathoanatomical autopsy. Place of origin of appendix vermiformis, from wall of intestinum caecum is determined by anatomical dissection. Intestinum caecum has a variable shape and it occurs in two forms: conical, which dominates (56%) and square (44%). It has constant position in fossa iliaca dextra in 100% of 50 investigated cases. Appendix vermiformis is fully variable organ as for position and the place of origin from the wall of intestinum caecum. Dominantly (52%) it has rising position, and two subtypes are present: retrocecal (more expressed-38%) related to the retrocolic subtype (14%). Very frequent position of appendix vermiformis is a falling one (32%), in which pelvic position is more frequent (26%) related to descendent position (6%). Appendix vermifirmis is located subcaecaly in 8% of total number of investigated cases, found in three subtypes. It is found out that ostium appendicis vermiformis has a variable position in the wall of intestinum caecum. It is predominantly placed in the middle of the lower pole of the intestinum caecum (58%), in medial wall it is present in 32%, of all investigated, and in the lateral wall in the least number case 10%. The results of these investigations point out how important is to know variable anatomies of appendix vermiformis, for the clinical image of acute appendicitis is undoubtedly caused by the variable anatomical relations.