PURPOSE To compare image quality, radiation dose, and their relationship with heart rate of computed tomographic (CT) coronary angiographic scan protocols by using a 128-section dual-source CT scanner. MATERIALS AND METHODS Institutional review board approved the study; all patients gave informed consent. Two hundred seventy-two patients (175 men, 97 women; mean ages, 58 and 59 years, respectively) referred for CT coronary angiography were categorized according to heart rate: less than 65 beats per minute (group A) and 65 beats per minute or greater (group B). Patients were randomized to undergo prospective high-pitch spiral scanning and narrow-window prospective sequential scanning in group A (n = 160) or wide-window prospective sequential scanning and retrospective spiral scanning in group B (n = 112). Image quality was graded (1 = nondiagnostic; 2 = artifacts present, diagnostic; 3 = no artifacts) and compared (Mann-Whitney and Student t tests). RESULTS In group A, mean image quality grade was significantly lower with high-pitch spiral versus sequential scanning (2.67 ± 0.38 [standard deviation] vs 2.86 ± 0.21; P < .001). In a subpopulation (heart rate, <55 beats per minute), mean image quality grade was similar (2.81 ± 0.30 vs 2.94 ± 0.08; P = .35). In group B, image quality grade was comparable between sequential and retrospective spiral scanning (2.81 ± 0.28 vs 2.80 ± 0.38; P = .54). Mean estimated radiation dose was significantly lower (high-pitch spiral vs sequential scanning) in group A (for 100 kV, 0.81 mSv ± 0.30 vs 2.74 mSv ± 1.14 [P < .001]; for 120 kV, 1.65 mSv ± 0.69 vs 4.21 mSv ± 1.20 [P < .001]) and in group B (sequential vs retrospective spiral scanning) (for 100 kV, 4.07 mSv ± 1.07 vs 5.54 mSv ± 1.76 [P = .02]; for 120 kV, 7.50 mSv ± 1.79 vs 9.83 mSv ± 3.49 [P = .1]). CONCLUSION A high-pitch spiral CT coronary angiographic protocol should be applied in patients with regular and low (<55 beats per minute) heart rates; a sequential protocol is preferred in all others.

Electrophysiological Evaluation of the Incidence of Martin-Gruber Anastomosis in Healthy Bosnian Population Background: Martin-Gruber anastomosis (MGA) is the well known anostomosis that occur at the various levels between the median and ulnar nerves. This anastomosis involves axons leaving either the main trunk of median nerve or the anterior interosseous nerve, crossing through the forearm to join the ulnar nerve. Knowledge of the incidence of this anastomosis is necessary because MGA can cause confusion in the assesment of nerve injuries and compressive neuropathies. Aim: We aimed to assess the occurance and motor velocities of median to ulnar nerve communication (MGA) in the forearm of Bosnian population by electrophysiological examinations. Material and Methods: One hundred and twenty forearms from a series of 60 volunteers (25 females, 35 males, 23-78 years of age) were studied electrophysiologically using needle recording electrodes. Volunteers with peripheral neuropathies were excluded from the study. Needle recording electrodes were places on the thenar and hypothenar muscles. The median and ulnar nerves were stimulated supramaximally at the wrist and the elbow and compound muscle action potentials (CMAPs) were recorded as well as motor conduction velocities of median and ulnar nerves. Results: Martin-Gruber anastomosis was found in 27 of 120 forearms; it was bilateral in 7 and unilateral in 13, on the right side in nine and on the left side in four forearms. There were no significant sexual differences in the incidence. In MGA, when stimulating median nerve the respond of abductor digiti minimi was registered in 11, whereas the respond of opponens pollicis when stimulating ulnar nerve was registered in 18 subjects. This finding was statistically significant. Conclusion: With high incidence of MGA in Bosnian population, it is necessary to be aware of the existance of this anomaly, location and its possible presentation.

Isolated splenic metastasis arising from a colorectal carcinoma is a rare finding. We report a case of 74-year-old man with a medical history of diabetes type II and paroxysmal atrial fibrillation, who underwent a right hemicolectomy for an adenocarcinoma of caecum in August 2004. In June 2007 the patient was diagnosed with high grade aortic valve stenosis as well as long segment stenosis of the first obtuse marginal branch of left coronary artery. He was suggested aortic valve replacement with coronary artery bypass grafting but he refused the surgery. In October 2007 the patient underwent alpha 18FDG - PET scanning, due to increasing values of CEA serum level, which showed a 5 cm big isolated hypermetabolic lesion in the spleen. Due to operative risk, splenectomy was refused by surgeons. The patient underwent a chemotherapy with capecitabine in total of 8 cycles before his CEA level began to rise and MSCT showed a progression in size of splenic metastasis. The patients condition was reevaluated by a team of experts and splenectomy was performed in September 2008. In May 2009 during the postoperative follow up, MSCT scanning revealed enlarged lymph nodes in celiac region and hepatic lesion suspicious of metastasis and the patient was admitted for further chemotherapy treatment. There is still no standardized treatment for this condition due to small number of cases reported in literature. Splenectomy followed by chemotherapy seems to be an optimal treatment but still no final conclusions can be made.

Uvod. Analizirati elemente interakcije koji doprinose uspostavljanju kvalitetau komunikaciji između ljekara i bolesnika sa dijabetesom na nivou primarnezdravstvene zastite. Analizirati uticaj odnosa ljekar - bolesnik na ishodelijecenja dijabetesa.Metode. Studijom je obuhvaceno osam ljekara i sezdeset bolesnika oboljelihod dijabetes mellitus-a tip 2, izabranih prema specificnim kriterijumima.Ljekari su podijeljeni u dvije grupe. Eksperimentalnu grupu su cinili ljekarisa zavrsenom obukom iz komunikologije. Kontrolnu grupu su cinila cetiriljekara opste prakse bez obuke iz medicinske komunikologije. Svaki ljekar jepratio grupu od sedam ili osam bolesnika sa dijabetesom.Interakcija između ljekara i bolesnika je procjenjivana primjenom Bales-oveanalize interakcijskog procesa. Tokom devet mjeseci praceni su funkcionalniishodi tretmana, vrijednosti glikemije i HbA1c, saradnja i zadovoljstvo bolesnika.Rezultati. Razlike u ponasanja ljekara eksperimentalne i kontrolne grupe subile visoko znacajne po svim kategorijama Bales-ove analize. Kontrola vrijednostiglikemije i Hb1Ac je bila bolja kod ispitanika koji su: imali kontrolunad konsultacijom, aktivno ucestvovali u lijecenju, pokazivali emocije, tražiliinformacije i razmjenjivali misljenje sa ljekarom. Ispitanici eksperimentalnegrupe su imali statisticki znacajna poboljsanja funkcionalnih parametara imanje funkcionalnih ogranicenja nakon devet mjeseci, te su bili statistickiznacajno zadovoljniji njegom i karakteristikama ljekara.Zakljucak. Dobra komunikacija sa bolesnikom znacajno utice na poboljsanjeishoda lijecenja bolesnika sa dijabetesom. Praktikovanje modela njege usmjereneka bolesniku dovodi do potpunije razmjene informacija između bolesnika iljekara, vece zdravstvene aktivnosti i odgovornosti bolesnika, te uspostavljanjaefikasnije saradnje i zadovoljstva bolesnika. Obuku iz medicinske komunikologijetreba sprovoditi na svim nivoima studija medicine.

Introduction: Surgical intervention and anesthesia procedure lead to a series of hormonal changes in the organism, which is mainly attributed to catecholamine response to stress. Surgical intervention is resulting in significant changes in neuroendocrine regulation, metabolism and physiological functions, as part of the overall response to stress. Research aim: The aim of this study was to determine and evaluate the levels of hormones in patients undergoing transvesical prostatectomy under general or local anesthesia. Material and methods: The study included a total of 100 patients from the Clinic of Urology, Clinical Center of Sarajevo who underwent surgery by technique of transvesical prostatectomy (BPH) in which the indicators were set:: a) repeated urinary retention; b) calculosis and diverticulosis of the urinary bladder; c) urinary infection, d) repeated massive hamaturia and e) the distal obstruction that can lead to uremia. Results: General anesthesia may limit the perception of stimuli from injury, but does not eliminate the full response to noxious stimuli, even with deep anesthesia. All intravenous agents andvolatile anesthetics in normal doses have little effect on the endocrine and physiological functions. Neural blockade induced by regional anesthesia or local anesthetics have a direct impact on endocrine and metabolic response. Regional anesthesia with the present consciousness, but with sympathetic blockade caused a greater suppression of hormonal responses than the general balanced anesthesia. In our research we obtained: a) a significant increase in prolactin intraoperatively, for respondents under general anesthesia; b) a significant increase in TSH values intraoperatively for respondents under general anesthesia; c) a significant drop in T4 intraoperatively in patients with regional anesthetic technique; d) a significant increase in cortisol values 24 hours postoperatively in patients with regional anesthetic technique.

The most common oral solitary pigmented lesion is the dental amalgam tattoo. It occurs as a result of colouring of the tissue by alien pigment which was administered intra or subepidermaly either intentionally or accidentally. The most common material used for the colouring of the oral mucosa is amalgam from amalgam fillings and metal particles from prosthetic restorations which are absorbed accidentally. The oral mucosa tattoos are most often found in the area of the marginal gingiva or the buccal mucosa. The metal particles may accidentally reach the area of the oral mucosa during various dentistry interventions. The therapy most often involves surgical intervention with excisional biopsy while in the recent period the low power laser therapy has provided exceptional results. The aim of the paper was to present the successful removal of the oral mucosa tattoo in a single visit.

Introduction: Social network is a social structure made up of individuals and organizations that represent “nodes”, and they are associated with one or more types of interdependency; such as: friendship, common interests, work, knowledge, prestige and many other interests. Beginning with the late twentieth and early twenty-first century, the Internet was a significant additional tool in the education of teenagers. Later, it takes more and more significant role in educating students and professionals. Goal: The aim of this paper is to investigate, to what extent and how effectively the Internet is used today. In addition, more specifically, this paper will research the implications of the well-known social networks in education of students and health professionals in Bosnia and Herzegovina (B&H). Material and methods: We compared the ratio of using Medline, as the largest biomedical data base system for spreading medical information, as basics for health education at biomedical faculties at five universities in B&H. Results and discussion: According to data from the CRA (i.e. Communications Regulatory Agency) in B&H, in 2010, there were 522,364 internet access accounts, with about 2 million Internet users, representing about 52% of the total population. The Internet users’ preference is dominated by the users of fast broadband access (e.g. xDSL) with 42.8%, and elsewhere, still with dialup access, with 25.2%. The results showed that only 11.6% of professors use Facebook type of social network, 49.3% of them have a profile on BiomedExperts scientific social network and 79% have available articles in the largest biomedical literature database MEDLINE. Students are also frequent users of general social networks and educational clips from You Tube, which they prefer to utilize considerably more than the other types of professionals. Students rarely use the facilities of professional social networks, because they contain mainly data and information needed for further, postgraduate professional education. In our research, we analized cited published papers in the journal Medical Archives, the oldest medical journal in B&H (established in 1947) of randomly included 151 full and part time professors, authors from five medical faculties in B&H and B&H authors who currently work in the EU and USA.. ANOVA showed that there was no significant difference in the number of articles published between the Universities in Bosnia, but there was significant difference in the number of articles published on MEDLINE, between all faculties in B&H and a group of scientists who work around the world. Students’ tests showed that there was a statistically significant difference in the average number of papers published on Medline, between groups of part-time and full time professors. However, there were no statistically significant differences, between the professors for preclinical and clinical subjects. Conclusion: In B&H there are decent conditions for the use of online social networks in the education of health professionals. While students enthusiastically embraced these opportunities, this is not so much a case with health care professionals in practice; while scientific health care workers have not shown greater interest in the use of social networks, both for purposes of scientific research and in terms of self-education and training of students. There is much more use of the advantages offered by online social networks, both in education and in support of the scientific research.