Introduction: It is a well recognized fact that a significant proportion of patients operated on for lumbar disc herniation exhibit a poor outcome, regardless of the apparent technical success of the operative procedure itself. Aim: to identify a set of widely available variables that accurately predict short-term outcome after discectomy and to develop a predictive model based upon those variables. Patients and methods: Basic demographic, clinical and radiological variables were evaluated in a group of 70 patient operated on for disc herniation. Outcome was assessed using VAS and RM scales 6 months postoperatively and correlated to aforementioned variables. Results: Preoperative pain intensity and duration, age and type of disc herniation were all shown to be statistically significant predictors of short-term outcome, unlike sex, type of radiological investigation and preoperative tension sign testing results. Multivariate regression analysis including only variables previously identified as good outcome predictors revealed that the pain intensity exhibited the strongest correlation with outcome, followed by pain duration, type of disc herniation and age. Even though MR scan was more sensitive in detecting disc extrusion than CT (sensitivity of 100% versus 65%, respectively), the presence of preoperative MR scan did not influence the outcome. Conclusion: The study identified a set of widely available and easily attainable variables as fair predictors of short-term outcome after lumbar discectomy. Subsequent logistic regression resulted in a predictive model whose accuracy is to be determined in another prospective study.

Background: Many efforts have been made to find diagnostic tools that would help select children with clinical signs of acute appendicitis that would need immediate appendectomy and to find tools that would reduce the numbers of negative appendectomies. Aim: We aimed to show the association between leukocyte count, level of C-reactive protein and interleukin-6 in peripheral blood on the one side and the degree of histological findings on appendix after appendectomy on the other side in children with high clinical probability for appendicitis (Alvarado score>7). Methods: We analyzed 80 patients of both genders, younger than 15 years, with Alvarado score>7, which underwent open appendectomy with subsequent histological analysis of removed appendices. We sampled 20 consecutive cases without signs of inflammation (group I), 20 cases with pathological signs of incipient inflammation (group II), 20 cases with signs of phlegmonous inflammation (group III) and 20 cases with signs of perforated appendix (group IV). Prior to appendectomy, a peripheral blood was sampled and sent for analysis of leukocyte count and C-reactive protein and interleukine-6 level. We compared values of all 3 measured parameters according to histological findings; we also used Receiver Operating Characteristics (ROC) analysis in order to evaluate diagnostic thresholds for detecting the histological signs of appendicitis. Results: The lowest values of all observed parameters were found in group of negative appendicitis while highest were observed in the group of perforated appendicitis. We have observed a significant between group differences in values of all three parameters according to the degree of histological inflammation (p<0.001). ROC analysis demonstrated that interleukine-6 had the best diagnostic performance in detecting patients with histological signs of appendicitis (AUROC=0.99; 95% CI=0.99-1.00) when compared to CRP and leukocyte count (p<0.05). There was no significant difference in diagnostic performance between CRP and leukocytes counts (p=0.35). Conclusion: Leukocyte count, CRP and interleukine-6 are very useful markers which may help in diagnostics and differentiation of phlegmonous and perforated appendicitis. In patients with high probability of appendicitis, measurement of interleukine-6 may help in better patient selection.

Introduction: clinical examination and surgical procedures require the knowledge of anatomical peculiarities of a complex area such as neck, especially if the anomalies in develoment of vascular system may occur. Aim: to investigate the mutual relation of the initial parts of the internal carotid artery and the external carotid artery, as well as the height of crossing of these blood vessels. Patients and methods: we evaluated 50 patients referred to diagnostic center of the PZU „Medicom“ Zenica, by using of magnetic resonance imaging (MRI) of the neck. Results: External carotid artery is placed medially and goes to the frontal side of the internal carotid artery in 90% cases. In 7% of cases the right internal carotid artery is placed laterall from the internal carotid artery. Divergent position, where the internal carotid artery (medially) and the external carotid artery go away from each other, was found in 1% of cases. We also found that the internal carotid artery and external carotid artery cross approximately 3.04 cm above the bifurcation (at right 3.05 cm and at left 3.12 cm) and the height of the crossing varies from 1.3 cm to 4.2 cm (at right 1.3 cm to 4.2 cm, and at left 1.5 cm to 4.1 cm). The height of crossing is symmetric in 18% of cases. Reversal of the position of the external and internal carotid arteries was found in 7% cases. Conclusion: The possibility of an inversed disposition of the internal and external carotid arteries must be held in mind when performing arterial ligatures in the carotid triangle, to avoid damage to the internal carotid artery or haemorrhagic accidents.

Introduction Temporomandibular dysfunction (TMD) denotes diseases of the muscles and the mandibular joint, muscular and skeletal diseases, and frequently also parts of systemic diseases of a generalized fibromy-algia, or a form of rheumatoid arthritis. In addition, fear, tension and stressful situations contribute to the overall condition of the masticatory system. (1) Some authors believe that TMD includes pathological diseases primarily affecting the function of muscles and the mandibular muscle, with a possible alteration to the tooth surface. (2) After a cause has crossed the level of individual physiological tolerance of the masticatory system, the system itself starts to respond with certain signs of change. Changes usually happen on the temporomandibular joints (TMJ), supportive tooth structures, and the teeth themselves. (3) The most frequent symptoms of TMD are found in the area of the temporomandibular joint, a sensation of fatigue in the jaw area, a sensation of stiffness of the jaw upon waking up or when opening the mouth, luxation or locking of the mandible when opening the mouth, pain when opening the mouth, and pain in the region of the temporomandibular joint or in the area of the masticatory muscles (cheeks). The most frequent signs of TMD include restricted mandibular movement , lower TMJ function, painful mandibular movement , muscle pain, and pain in the TMJ. (4) TMD causes are complex and multi-factori-al. Numerous factors may lead to TMD. The influence of psychosocial stressors, parafunctions and other psychological and behavioral processes onT-MD pain has been examined in a number of studies. For example, war-related stress has been linked to TMD (5), and stressors as mild as performing mental arithmetic and solving five-letter anagrams can also increase masticatory muscle activity thought to be associated with TMD. (6, 7) Similar relationships between stress and TMD have been reported in children, adolescents and adults. (8, 9, 10) The American Psychiatric Association (11) defines post-traumatic stress disorder (PTSD) as a form of pathological response to stress, in which the patient, through intrusive thoughts and dreams, regularly experiences the trauma suffered, and is consequently placed in a state of permanent increased tension. As a result of increased motor activity and the neu-rotransmitter disruptions which accompany PTSD, particularly with regard to noradrenalin, serotonin, endogenic opiates, and the hypothalamic-pituitary-adrenal axis (12, 13, 14), marked manifestations of symptoms and signs of TMD can be expected. (5)