No abstract

High injection pressures at the onset of injection may indicate an intraneural needle placement and lead to severe fascicular injury and persistent neurologic deficits. If these results are applicable to clinical practice, avoiding excessive injection pressure during nerve block administration may help to reduce the risk of neurologic injury.

The data in our canine model of intraneural injection suggest that intraneural injections do not always lead to nerve injury. High injection pressures during intraneural injection may be indicative of intrafascicular injection and may predict the development of neurologic injury.

No abstract

Specific response to nerve stimulation with currents <0.2 mA occurred only when the needle tip was positioned intraneurally. However, motor response could be absent with intraneural needle placement at a current intensity of up to 1.7 mA.

The great diffusion of the surgical techniques in jaws surgery and the progress of the radiological imagining procedures expressed many interest in clinical anatomy of the mental foramen (MF). The study goal was to determine the precise location of the MF and the surrounding anatomical landmarks. Measurements of the MF position relative to the surgical landmarks and related posterior teeth were made on 20 dry mandibles with complete dentition and intact alveolar bridge obtained from the Institute of Anatomy, School of Medicine, University in Sarajevo. The measurements were made by anthropometric methods on the booth sides of the mandible, and compared with measurement made on the orthopantomogram radiographs of the same mandibles. The most common position of the MF was in line with the longitudinal axis of the second premolar. In the vertical plane on the skulls the MF lays in the midpoint of the distance between the lower border of the mandible and the alveolar margin, however on the orthopantomogram MF appeared slightly bellow the midpoint. In the horizontal plane it lays approximately one third of the distance between the mandibular symphysis and the posterior border of the ramus of the mandible measurement from A-P projection and one quarter of that distance measurement from the profile projection. There were no significant differences between distances MF from posterior border of the ramus of the mandible measurement from A-P and profile projection and the one obtained on orthopantomogram and their ratio is constant value determine das 1,065. The MF was on average 25 mm lateral to the mandibular skeletal midline and symmetrical, and symmetry was preserved on the orthopantomogram. The measurement showed significant differences in distances of M from superior border mandible measurement on dry mandible and orthopantomogram radiographs while distance bellow the MF was not significantly different. The constant values of MF distance to the posterior border of the ramus of the mandible measured as 1,065 and the distance to the medial skeletal line of 2,11 made it possible to also determine average angle of 43 degrees stream of the cor-pus of the mandible behind MF. These values in combination with ratios of MF to the different anatomic landmarks designated as relative horizontal and relative vertical position, would be of importance not only from anatomical but also from practical point of view for estimation of alveolar bridge resorption and preoperative analysis in orthognat postresection or implant surgery in the mandible.

In the last few decades there has been a great development of regional anesthesia; all the postulates are defined and all the techniques of usage are perfected. However, like any other medical procedure, the block of brachial plexus carries a risk of certain unwanted complications, like possible intraneural and intravascular injections. The reason for great discrepancy between the injury of brachial plexus and other periphery nerves while performing the nerve blockade is the frequent usage of this block, but also the specific proximity of neurovascular structures in axilla. The purpose of this work is to determine the values of pressures which appear in para-neural, intraneural and intravascular injection applications of local anesthetic, and to compare those values in order to avoid cases of intraneural and intravascular injections in clinical practice with consequential complications. In experimental study there have been used 12 Wistar rats of both genders. After anesthesia with ether and mid-humoral access to the neurovascular structures in axilla, the injection of 2% lidocaine with epinephrine was performed with the help of automatic syringe charge. The needle was at first placed para-neural, and then also intraneural and intravascular. During every application the pressure values were monitored using the manometer, and then they were analyzed by special software program. All para-neural injections resulted with the pressure between 13,96-27,92 kPa. The majority of intraneural injections were combined with the injection pressure greater than 69,8 kPa, while the intravascular injections were combined with injection pressure less than 6,98 kPa. Based on the available data it can be noticed that so far none of the methods of prevention from unwanted complications of regional anesthesia can insure the avoidance of intraneural and intravascular injection of local anesthetic. Based on our research it is obvious that the measuring of pressure during the nerve blockade is very important in order to decrease the risk of neurological and possible systematic complications. It is also clear that a small, mobile, and financially quite available apparatus for pressure measurement can help in differentiation between para-neural, intraneural and intravascular injection. Avoiding high injection pressure prevents from lodging the needle into intraneural space, while avoiding a very low injection pressure prevents from lodging the needle into intravascular space followed by consequential complications. The usage of this apparatus can find its application in other blockades of periphery nerves, and in other branches of medicine as well.

Telemedicine (distance medicine) represents a field of medicine that has been in a tremendous expansion over the last couple of years thanks to the fast development of telecommunications and reduction of their costs. It enables a direct communication (visual) between the peripheral hospitals and referral facilities in the interior of the country as well as a connection of centres with referral centres abroad in the fields of diagnostics, consultations or education. The main objective is to encourage interest in telemedicine among physicians and other health care experts, initiate an exchange of opinions, and experience about the application of telecommunication technology in medicine, so to reach a common perception of its role in the context of future development of the health care system in Bosnia and Herzegovina. As a standard, current equipment consists of computers, which are equipped with frame grabbers and communication modem for communication through a public telecommunication system. Input data can all be visual data (X-Ray, CT, MRI, ultrasound, ECG, histological finding, cariogram, and of course photos of the patients, of operational/surgical field. The Institute of Pathology of the Sarajevo Medical Faculty has actively participated in the experimental project "SHARED" (1996-2000) together with the Radiology and Ophthalmology Clinic of the Sarajevo Clinical Centre. The past experience in using telemedicine has shown that the introduction of such a telemedicine system in B&H would be of great significance in the future in the context of providing better and more efficient health services to the patients. In practice, that means a more simple approach to some services and data for patients, a better and faster circulation of information and experience of medical experts and health care workers with cost control at the same time.