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Introduction: Emergency medicine is a new academic discipline, as well as a recent independent clinical specialization with the specific principles of practice, education and research. It is also a very important segment of the overall health care and health system. Emergency medicine as a distinct specialty was introduced in the U.S. in 1970. Ten years later and relatively quickly emergency medicine was introduced in the health system in Bosnia and Herzegovina as a specialty with a special education program for specialist and a final exam., Goal: Compare the development of emergency medicine in Bosnia and Herzegovina with the trends of development of this discipline in the world as a specialization and an academic discipline. Identify specific problems and possible solutions and learn lessons from other countries., Methods: Reviewed are the literature data on the development of emergency medicine in the world, programs of undergraduate and postgraduate teaching, the organizational scheme of emergency centers and residency. This is then compared with data of the current status of emergency medicine as an academic discipline and a recognized specialization, in Bosnia and Herzegovina., Results: There are substantial differences in the development of emergency medicine in the United States, European Union and Bosnia and Herzegovina. Although Bosnia and Herzegovina relatively early recognized specialty of emergency medicine in academia, it failed to mach the academic progress with the practical implementation. A&E departments in the Community Health Centers failed to meet the desired objectives even though they were led by specialists in emergency medicine. The main reason being the lack of space and equipment as well as staff needed to meet set standards of good clinical practice, education and research. Furthermore the Curriculum of undergraduate education and specialization does not match modern concept of educational programs that meet the principles set out in emergency medicine and learning through practice., Conclusion: The Development of emergency medicine as a separate specialization and independent academic discipline has had different way and pace of development, and there is no ideal model that can be applied in all countries. However experiences from countries with well developed emergency medicine, suggest that the model of the simultaneous development of emergency medicine as a distinct academic discipline on independent recognized residencies with a strong national association is the best way for the formation of an efficient health system. The establishment of Emergency centers--departments for emergency medicine at university and cantonal hospitals, introduction of emergency medicine as an academic discipline, implementation of specific post-graduate teaching and continuing medical education through appropriate courses, as well as academic development program for the teaching staff is the most important element of future development of this discipline. It would also contribute to it achieving the appropriate status in both the academic institutions and in practice within the health system of Bosnia and Herzegovina.

Unlabelled: Stroke is a clinical syndrome characterized by the sudden occurrence of a permanent focal neurological deficit. The most common causes of death are transtentorial herniation, pneumonia, pulmonary embolism and heart disease. According to literature data, pulmonary embolism (PE) is responsible for 5% of deaths after stroke., Aim: The aim of this article is to determine the incidence of patients who had secondary vascular complications in the form of PE and deep venous thrombosis (DVT) after stroke and indicate the need for creating and promoting the algorithm for these complications in patients after stroke., Material and Methods: The study included 86 patients hospitalized at the Clinic of Physical Medicine and Rehabilitation in the period from October 2008 to October 2009 who have had rehabilitation as a continuation of the treatment immediately after the stroke., Results: Hemorrhagic type was present in 13% of patients, and ischemic in 87%. As a secondary complication after stroke, five patients had pulmonary embolism. Neurological deficit in these patients was in the form of hemiplegia and were with ischemic type. Time from stroke until the appearance of symptoms of pulmonary embolism was in average 25.4 days. Suggested thrombi prophylaxis therapy (which they received before rehabilitation) in patients who have developed PE was Aspirin Protect, while no patient had recommended low molecular heparin. Physical therapy was performed for all patients, and mechanical methods of prophylaxis were used., Conclusion: Different attitudes about prophylaxis effects for these patients should be regulated by a unique algorithm that would reduce the possibility of discrepancy in therapeutic sense. That is why for patients with acute stroke and limited mobility it is recommended to use heparin or low molecular heparin (LMH) in preventive doses, if there are no contraindications for anticoagulants, with physical therapy and mechanical methods of prophylaxis.

Introduction: the lower extremity requires an understanding of the ways in which such reconstruction differs from that of the upper extremity. The weight-bearing requirements are the most obvious difference. The difference between the cutaneous coverage on the plantar surface on the foot and that on the dorsum has important implication for reconstruction of defects in these areas. There are few operative techniques for reconstruction of the posttraumatic heel defects, in our study we have been compared two techniques, free microvascular flap and reverse supramaleolar fasciocutaneous flap., Aim: the aim of the study is evaluation of the appearance of stress ulcers as late complications of the heel reconstruction, comparing these two methods., Material and Methods: in testing were included 50 patients with posttraumatic heel defects, of different etiology, divided in two groups. The first group of 25 patients with posttraumatic heel defects has been treated by microvascular free flap. The other group of 25 patients with posttraumatic heel defects has been treated by reverse supramaleolar fasciocutaneous flap., Discussion: according to our results, there are significant differences between proportions of patients with and without of late complications of free microvascular flap comparing with reverse supramaleolar fasciocutaneous flap., Conclusion: stress ulcers, as result of continuous pressure on weight-bearing area, have been evaluated by using both operative methods. Reverse supramaleolar fasciocutaneous flap is good alternative method for heel reconstruction.

Authors present own experience after use surgical correction technique in order to heal the complex hallux valgus deformity. In period 1999-2002 we used this technique on 5 patients (4 females, 1 male) with 6 surgical procedures (1 female had bilateral treatment). Indications for surgical treatment were functional problems and x-ray angle between the first and second metatarsals as well as valgus angle of the first metatarsophalangeal joint which were much higher. Pre-surgical, possibility of correction angle was exact by x-ray planing. The same examination was done after surgical treatment. After surgical care and rehabilitation program all patients had well biomechanical foot relation and they had not previous functional problems.