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Objectiv: Anatomic characterization of the nutrient artery of upper extremity long bones differs among the several textbooks on human anatomy. To elucidate the anatomical features of the nutrient foramen (NF) through which the nutrient arteries pass, we examined the morphology and topography of the NF on the diaphysis of the long bones of the upper extremities. Methods: A total of 150 (50 humeri, 50 radii, 50 ulnae) macerated and degreased adults, long bones of the upper extremities, unknown age, and gender were used as material in this study. The following parameters were determined for each bone: total number of NF, foramina index (FI), total bone length, position of the NF based on the FI value and the surface of the shaft/body of the bones, and obliquity of the nutritional canal (NC). Results: The largest number of NF was found on the middle third of the anteromedial side of the humerus diaphysis, with NC directed distally, that is, towards the elbow. Radius and ulna had predominantly one NF, on middle third of anterior surface, with NC directed proximally. Conclusion: This study provides additional and important information on the location and number of NF in the long bones of the upper and lower extremities in the Bosnian and Herzegovinian population.

Aims: Nutrient artery is the principal source of nutrition to the long bones. The topography of nutrient foramina on long bones is well known, but it has not yet been established whether the number of nutritive foramina (NF) is related to total bone length. The objective of the present study was to study the correlation of total number of nutrient foramina and long bone length of upper and lower limb to provide detailed data on such features. Study Design: A cross-sectional, descriptive study Place and Duration of Study: Department of anatomy, Medical Faculty University of Sarajevo. Study duration was 3 months. Methodology: In the present study, 300 adult human long bones of the upper (50 humeri, 50 radii, 50 ulnae) and lower (50 femora, 50 tibiae, 50 fibulae) limbs were investigated to determine the number of their nutrient foramina. The nutrient foramina were identified analysed macroscopically and total number of nutrient foramina for each bone was recorded. Total length of each bone within a group was recorded. Statistical analysis was performed to determine correlation between total bone length and number of nutrient foramina, by using SPSS version 17.0 for Windows. Results: A statistically significant negative correlations between the left humerus length and the number of NF was found. A positive correlations between the length of the right radius and the number of NF, the left ulna length and the number of NF, the right ulna length and the number of NF were found. A negative correlations between the length of the left radius and the number of NF and between right humerus length and number of NF were found. A positive correlation between the length of the right and left femur and the number of NF were found. A negative correlation between the length of left tibia and the number of NF was found, as well as negative correlation between the length of right and left fibula and number of NF. Conclusion: Total bone length is not related to the number of nutrient foramina. The number of nutrient foramina does not depend on the total length of the bone, which is important when assessing the success of grafts for transplantation on long bones in taller people.

Background: Zearalenone is a widely spread mycotoxin, contaminant of most cereal grains. It has uterotropic, estrogenic and anabolic activity in farm animals. The results are hormonal disbalances as hyperestrogenism, Zearalenone inhibits follicle-stimulating hormone production, thus supressing ovarian follicle development and ovulation. Also, it induces oxidative stress. Melatonin acts as a potent natural antioxidant and regulates the reproductive function by modification of steroidogenesis. Objective: The present study was conducted to provide detailed qualitative histological analysis of uterus of female rats treated with zearalenone and melatonin and contribute to better understanding of the topic. Methods: Forty adult, female Wistar rats were equally divided into five groups: Z group – zearalenone, 0,3 mg/kg, i.g.; M group – melatonin, 10 mg/kg, i.p.; ZM group –concomitant application of zearalenone and melatonin in the same dosing regimen, VZ group–zearalenone vehiculum/sunflower oil, i.g. and MZ group–melatonin vehiculum/5% ethanol in Ringer, i.p. Animals were treated daily for 28 consecutive days. After that period, all animals were sacrificed to obtain samples for qualitative histological analysis using the light microscope. Results: Zearalenone led to the alterations of the uterine structures, predominantly in the endometrium that were characterized by metaplasia and hypertrophy of the epithelial cells and hypercellularity of the stroma. In the myometrium, zearalenone induced hypertrophy and hyperplasia of the myocytes. Conclusion: Melatonin, when applied together with zearalenone, blocked the adverse effects of the zearalenone.

Objective. The objective of this study was to study the morphometry of the styloid process of the temporal bone and the prevalence of an elongated styloid process in relation to side and gender.Material and Method. The present study included 200 human skulls which were procured from the rich osteological collections of the Department of Anatomy, Faculty of Medicine, University of Sarajevo. The styloid process was observed macroscopically on both sides of all the skulls and elongations, if any, were noted. The lengths of the styloid processes were measured using digital vernier calipers. The measurements were taken from the point of emergence of the process (base) up to the tip.Results. Out of 200 specimens, only 14 cases (7%) exhibited an elongated styloid process. The mean length of the styloid process was 25.8±4.68 mm and 24.2±4.54 mm for the right and left sides, respectively. The size of the styloid process did not different significantly between the two sides (P=0.724). The mean length of the styloid process was 24.05±3.54 mm in females and 25.95±5.68 mm in males, and the difference was statistically significant (P=0.023).Conclusion. The study and knowledge of the anatomical variations of the styloid process in the Bosnian population may help clinicians to diagnose Eagle’s syndrome. Knowledge of this disorder can prevent the worsening of the painful symptoms related to an elongated styloid process.

Testing strategies can either have a very positive or negative effect on the learning process. The aim of this study was to examine the degree of consistency in evaluating the practicality and logic of questions from a medical school pathophysiology test, between students and family medicine doctors. The study engaged 77 family medicine doctors and 51 students. Ten questions were taken from cardiac pathophysiology and 10 questions from pulmonary pathophysiology, and each question was assessed on the criteria of practicality and logic. A nonparametric Mann-Whitney test was used to test the difference between evaluators. On the criteria of logic, only four out of 20 items were evaluated differently by students in comparison to doctors, two items each from the fields of cardiology and pulmonology. On the criteria of practicality, for six of the 20 items there were statistically significant differences between the students and doctors, with three items each from cardiology and pulmonology. Based on these indicative results, students should be involved in the qualitative assessment of exam questions, which should be performed regularly under a strictly regulated process.

Introduction Spleen acts as blood reservoir both in animals and human beings. Spleen contracts during the exercise and so augment the systemic circulation and helps body to maintain longer on high intensity exercise. Reviewing all available literature, the human spleen shows a decrease in volume, in range from 8% to 56%, depending on the work intensity. Aim To evaluate the percentage of the decrease in splenic volume after the treadmill exercise at specific workloads: aerobic threshold intensity, anaerobic threshold intensity, submaximal intensity and maximal intensity. Methods This prospective study with repeated measurements included 16 healthy subjects, divided in two groups. First group consisted of 8 elite long-distance runners and second group of 8 recreational runners. First testing consisted of treadmill ergospirometry test. This data was crucial for the second testing where subjects were exercising on treadmill at specific workloads. Four specific workloads were determined: treadmill exercise at aerobic threshold intensity (1st workload), anaerobic threshold intensity (2nd workload), submaximal intensity (3rd workload) and maximal intensity (4th workload). Workloads were controlled by the speed of treadmill, for each subject individually regarding the ergospirometry test. Ultrasound measurement of spleen was done before and after each workload. Results Elite long-distance runners showed greater spleen contraction than recreational runners after four workloads. Spleen contraction was the biggest after the 3rd workload in elite long-distance runners. Smallest contraction was in group of recreational runners after the 1st workload. Statistically significant difference was not found between the groups, regarding the splenic volume after exercise at four specific workloads (p>0.05). Conclusion Elite long-distance runners had greater decrease in splenic volume than recreational runners, after exercise at four specific workloads, without significant difference. Greatest decrease happened in elite long-distance runners, after exercise at submaximal intensity - 49% decrease in splenic volume.

The current intensity at which a motor response is elicited with an intraneural needle placement has been inadequately studied. We hypothesized that electrical current delivered through an intraneurally placed needle does not always result in an evoked motor response. Our secondary objective was to determine the relationship between electrical current intensity and needle-to-nerve distance.Twenty pigs were given general anesthesia and the sciatic nerves (SN) were exposed bilaterally. Electrical nerve stimulation was applied 2 cm, 1cm, 0.5 cm, 0.2 cm, and 0.1cm away from the SN, transepineurally, and intraneurally (in the subepineurium). Stimulation was started at 2.0 mA and decreased to the minimal current at which visible motor response was obtained. Two blinded observers agreed on the intensity and type of motor response. Specific response of SN was defined as a distal motor response (hoof twitch); nonspecific response was defined as a local muscle twitch (no hoof response).At a distance of 0.5 cm to 2 cm away from the SN, only nonspecific muscle responses were observed. Specific SN responses were obtained starting at 0.1 cm away from the nerve and transepineurally with currents of 0.92 +/- 0.33 mA (median 1.00 mA; range 0.24-1.48 mA) and 0.39 +/- 0.33 mA (median 0.3 mA; range 0.15-1.4 mA), respectively. With the needle tip positioned intraneurally, specific motor response could be obtained at 0.56 +/- 0.54 mA (median 0.3 mA; range 0.08-1.80 mA). Five (12.5%) intraneurally positioned needles only elicited a specific motor response at 0.8-1.8 mA.Specific response to nerve stimulation with currents0.2 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.

Background: Inadvertent intraneural injection of local anesthetics may result in neurologic injury. We hypothesized that an intraneural injection may be associated with higher injection pressures and an increase in the risk of neurologic injury. Methods: The study was conducted in accordance with the principles of laboratory animal care, and was approved by the Laboratory Animal Care and Use Committee. Fifteen dogs of mixed breed (16–21 kg) were studied. After general endotracheal anesthesia, the sciatic nerves (n= 30) were exposed bilaterally. Under direct vision, a 25-gauge, long-beveled needle (30°) was placed either epineurally (n= 10) or intraneurally (n= 20), and 4 ml of preservative-free lidocaine 20 mg/ml was injected using an automated infusion pump (4 ml/min). Injection pressure data were acquired using an in-line manometer coupled to a computer via an analog-to-digital conversion board. After injection, the animals were awakened and subjected to serial neurologic examinations. One week later, the dogs were killed, the sciatic nerves excised and histologic examination was performed by pathologists blind to the purpose of the study. Results: All perineural injections resulted in low pressures (≤ 5 psi). In contrast, eight of 20 intraneural injections resulted in high pressures (20–38 psi) at the beginning of the injection. Twelve intraneural injections, however, resulted in pressures of less than 12 psi. Neurologic function returned to baseline within 3 h after perineural injections and within 24 h after intraneural injections, when the measured injection pressures were less than 12 psi. Neurologic deficits persisted throughout the study period after all eight intraneural injections that resulted in high injection pressures. Histologic examination of the affected nerves revealed fascicular axonolysis and cellular infiltration. Conclusions: 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.

In this paper, we described osseous anatomy of the orbital apex using CT in axial and coronal projections. The main osseous landmarks facilitate the evaluation of orbital apex in radiology, especially on the axial and coronal CT scans. These landmarks include so called optic strut, small segment of the greater wing of the sphenoid bone and upper part of the pterygopalatine fossa. We also concentrate attention upon visualisation and review of the optic canal, superior and inferior orbital fissure, pterygopalatine fossa and foramen rotundum.

Introduction In this paper, we report our experience with a case of primary hydatid cyst involving only the spleen in a 27-year-old sportsman treated by PAIR technique. Case report Five years before, a 27-year-old handball player being admitted to our hospital, it was detected the cyst in his spleen which size was 35 x 30 mm in diameter, by abdominal ultrasound during a systematic examination. There was no pain or any other symptoms at that time. Tests on the presence of echinococcus cysts were negative. After a period of 5 years, and regular check-ups, the patient began to feel a dull pain in the left upper quadrant area. The Echinococcus test was again negative. Puncture and aspiration of content was performed and sent to cytological analysis that confirmed the presence of Echinococcus. The CT finding showed the spleen in a normal position, shape, enlarged, 185 mm in longitudinal diameter (splenomegaly), with inhomogeneous parenchyma on the expense of rounded area with hyperdense halo, which did not opacify after contrast, located in the dorsal area of the spleen, 100x98 mm in diameter and which corresponded to the echinococcal cyst in differential diagnosis-clean dense contents (protein / haemorrhagic). Conclusion The reported case is very specific, considering that handball is contact sport, where it is almost impossible to avoid the physical contact between players, which is sometimes even rough. Due to rough contacts, spleen trauma is something we should be very aware about, especially in cases of splenomegaly with hydatid cyst, where the spleen rupture might lead to fatal outcome. According to all this, careful follow up of this patient is necessary.

The aim of this work is to measure clinically important dimensions of thoracic and lumbal vertebras. Charts of one-hundred and seventeen patients with implanted internal fixateur on the thoracic and lumbal spine between 01.01. 2008. and 31.3.2010. at the Department for Orthopedics and Traumatology, of the Sarajevo Clinical center were retrieved, and only 14 patients, with 46 vetrtebras and 89 pedicles have had complete documentation (clearly visible measured structures on X-ray and CT scans). Digitalized antero-posterior and latero-lateral X-ray, and transversal and sagital CT scans were basic inputs for measurement of height and width of the pedicle – PH, PW, axial and vertical cortico-cortical transpedicular distances – AL, VL, and interpedicular distance – IP. The correction of enlargement on X-ray pictures was performed according to known dimensions of implants and length scale on CT scans. Enlargement of those parameters, from T1 to L5 level was from 50 to 150%. This increasing was not always linear, sometimes there was even decreasing. For instance, the IP on second and third thoracic vertebra was shorter compared to the first thoracic vertebra. Pedicles from the third to the eighth thoracic vertebra were narrower compared to the second thoracic vertebra. The importance of this work is in to analyze the mentioned dimensions by methods available to the clinician. Every other in vivo measurement is impossible because of the excessive surgical approach, while preoperative CT scanning with a great number of slices per one millimeter for this purpose is not ethical.

The aim of this study was to investigate possible differences in blood glucose levels between male and female rats immediately after acute bout of forced swimming exercise. Adult male Wistar rats (weight 300- 350 g) were divided into two groups by gender: males (n =8) and females (n =8). All the rats were given standard rat chow and tap water ad libitum and were housed at 25±3o C on a 12-hour dark/light cycle. Both groups of rats were exposed to forced swimming stress daily, for 6 days. Duration of each swimming session progressively increased from 5 minutes on the first day to 30 minutes on sixth day, allowing adaptation to swimming conditions. The rats were forced to swim in plastic tanks (90 cm wide, 120 cm deep) containing tap water (temperature ca. 25 degrees C). The depth of water was 40 cm. Seventh day we performed acute bout of 40 minutes swimming exercise. Animals were fasted 12 hours before start of last swimming sessions to obtain fasting blood glucose levels. Preexercise blood samples were taken immediately before last swimming session (7th day) and postexercise samples immediately after the last swimming session from rat's tail vein. Glucose levels in blood were determined using Optium Xceed™ Diabetes Monitoring System (Abbot). Before last swimming session male rats had slightly lower glucose levels in comparation with female rats, but this difference was not statistically significant (3.77vs4.64 mmol/l). Acute bout of forced swimming exercise raised blood glucose level and established values in postexercise period were significantly higher in both study group in comparation to values before exercise. Male rats had greater postexercise glucose blood levels (11.85 mmol/l) in comparation with female rats (6.26 mmol/l). Our findings document the existence of gender impact on the glucose postexercise concentrations confirming the differences in the energy substrates utilization and glucose metabolism regulation during and after exercise., Cilj ove studije bio je istražiti moguće razlike razine glukoze u krvi izmeðu muških i ženskih štakora odmah nakon akutnog opterećenja vježbom forsiranog plivanja.: Odraslih muški štakori soja Wistar (prosječne mase 300-350 g) su bili podijeljeni u dvije skupine po spolu: muški (n= 8) i ženski (n = 8). Svi štakori su dobili standardnu, komercijalnu hranu za štakore i vodu iz slavine ad libitum, a bili su smješteni na 25 ± 3 ° C na 12- satnom tamno / svijetlo ciklusu. Obje skupine štakora bila su izložene vježbama forsiranog plivanja,dnevno u trajanju od 6 dana. Trajanje svake sesije plivanja postupno se povećavalo sa 5 minuta prvog dana do 30 minuta šestog dana , čime se postigla prilagodba životinja na uslove plivanja. Sedmi dan smo izveli akutno opterećenje 40 minutnog forsiranog plivanja. Štakori su plivali u plastičnim spremnicima (90 cm širine, 120 cm dubine) koji su sadržavali vodu iz slavine (temperature približno 25 stupnjeva C). Dubina vode iznosila je 40 cm. Životinjama nismo davali hranu 12 sati prije početka posljednje sesije plivanja kako bi dobili razine glukoze u krvi natašte. Uzorci krvi za odreðivaje glukoze uzeti su neposredno prije posljednje sesije plivanja (7.dan) i neposredno nakon posljednje sesije plivanja iz repne vene štakora. Razine glukoze u krvi utvrðene su pomoću Optium ™ Xceed Dijabetes sustava praćenja (Abbot) . U uzetim uzorcima krvi neposredno prije posljedenje sesije plivanja utvrðene su nešto niže razine glukoze kod muških u usporedbi s ženskim štakorima, ali ta razlika nije bila statistički značajna (3.77vs4.64 mmol /l). Akutno opterećenje vježbom forsiranog plivanja podiglo je razinu glukoze u krvi i srednje vrijednosti u uzorku uzetom neposredno nakon posljednje sesije plivanja bile su značajno više u obje skupine u usporedbi s vrijednostima prije vježbanja. Muški štakori imali su značajno veću razinu glukoze u krvi (11,85mmol / L) u usporedbi sa ženskim štakorima (6,26 mmol / L). Naši rezultati ukazuju na uticaj spola na razinu glukoze nakon fizičkog opterećenja potvrðujući spolne razlike u iskorištavanju energetskog supstrata i i regulaciji metabolizma glukoze u toku i nakon vježbanja.

The blockade of peripheral nerves carries a certain risk of unwanted complications, which can follow after unintentional intraneural injection of a local anesthetic. Up till today, the research of measuring injection pressure has been based on animal models, even though the histological structure of periphery nerve is different for animal and human population, so the application pressure which presages intraneural injection in human population is still unknown. As material in performing this study there have been used 12 Wistar rats and 12 delivered stillborns. After bilateral access to the median nerve, we applied 3 ml of 2% lidocaine with epinephrine, with the help of automatic syringe charger. The needle was at first placed perineural on one side, and then intraneural on the other side of both examination groups. During every application the pressure values were monitored using the manometer, and then they were analyzed by special software program BioBench. All perineural injections resulted with the pressure < or = 27.92 kPa, while the majority of intraneural injections were combined with the injectionpressure > or = 69.8 kPa. The difference between intraneural and perineural injection pressures for the two different examination groups (rats and delivered stillborns) was not statistically significant (P>0.05). As prevention from intraneural injections today are in use two methods: the method of causing paresthesia or the method of using the peripheral nerve stimulator. However the nerve injury can still occur, independent from the technique used. If our results are used in clinical practice on human population, than the high injection pressure could be the markerof intraneural lodging of a needle.

Cerebral-vascular diseases present one of the leading problems of the modern mankind. They are followed by the risk of high mortality rate, and as such cause high level of disability with people who survive cerebral-vascular incident (stroke, apoplexy). Researches done so far proved that beginning, course and result of the cerebral-vascular diseases depend immensely of the possibility to establish collateral blood circulation and first of all on so called tertian level that is actually the circle of Willis. The circle of Willis, thanks to communicating segments, provide detour way to procure parts of the brain which, due to insufficiency, do not get enough quantity of blood. In this particular study by the analysis of 150 MRI patient’s angiographies of the circle of Willis that had been processed at the Radiology Institute of the Clinic Center of University in Sarajevo, we tried to present the most common variations of the posterior segment of the circle of Willis with patients who did not have signs of the cerebral-vascular diseases. The analysis included two target groups (above 60 years old and younger than 34 years old) and both genders. By the analysis of the angiographies of the circle of Willis we reached following results: complete posterior configuration of the circle of Willis has been found with all patients in 54% of cases, but in some slightly higher percentage complete posterior configuration is noted with younger category of patients compared to elderly patients, and in some higher percentage with female compared to male patients. Out of variations that damage the posterior segment of the circle of Willis the first one, according to the frequency of occurring, is the variation of the type of unilateral fetal sort of posterior cerebral artery, and then the variation marked as unilateral aplasia or hypoplasia of the posterior communicating artery.

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 paraneural, intraneural and intravascular injection applications of local anesthetic, and to compare those values in order to avoid cases of intraneural and in-travascular 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 midhumeral access to the neurovascular structures in axilla, the injection of 2% lidocain with epinephrine was performed with the help of automatic syringe charger. The needle was at first placed paraneural, 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 paraneural 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 paraneural, intra-neural 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.

As it is well known the beginning, the course and the result of the cerebral-vasculare disease depends on, among other stuff, the possibility of establishment of the brain collateral circulation. The Willis's artery circle based on brain is the most important anastomoses between the blood circulation of the both, carotid and basilar artery. However, in almost half of the cases of the examined circle of Willis, certain deviations from the normal anatomy configuration have been identified that immensely facilitate occurance of vascular diseases, because it makes difficult establishment of collateral blood circulation. In this particular study, 150 MRI patient's angiographics had been analyzed that were processed at the Radiology Institute of the Clinic Center of the University of Sarajevo. The morphologic variations of the circle of Willis were analyzed on these angiographics and those were patients who did not have any signs of cerebral-vasculare diseases. We have tried to determine which variations are the most commonly occuring in the front segment of the circle of Willis with two target groups (older -- above 60 years old and younger- up to 34 years old) and including both genders. The method of the MR angiography in two projections enabled good visualisation of all components of the circle of Willis and based on their analysis we have achieved the following results. The complete front configuration of the circle of Willis had been found with all patients in 76,7% of the cases. We noted slightly higher percentage of the anterior configuration with younger category of patients compared to older patients, and with males compared to females. Out of the variations that damage the anterior segment of the circle of Willis, the first one, according to the frequency of occuring, is the variation of the type of hypoplasia or aplasia of Al segment of the anterior cerebral artery, and then the variation marked as duplication or multiplication of the anterior communicating artery.

Background Unintentional intraneural injection of local anesthetics may cause mechanical injury and pressure ischemia of the nerve fascicles. One study in small animals showed that intraneural injection may be associated with higher injection pressures. However, the pressure heralding an intraneural injection and the clinical consequences of such injections remain controversial. Our hypothesis is that an intraneural injection is associated with higher pressures and an increase in the risk of neurologic injury as compared with perineural injection. Methods Seven dogs of mixed breed (15-18 kg) were studied. After general endotracheal anesthesia, the sciatic nerves were exposed bilaterally. Under direct microscopic guidance, a 25-gauge needle was placed either perineurally (into the epineurium) or intraneurally (within the perineurium), and 4 mL of lidocaine 2% (1:250,000 epinephrine) was injected by using an automated infusion pump (4 mL/min). Injection pressure data were acquired by using an in-line manometer coupled to a computer via an analog digital conversion board. After injection, the animals were awakened and subjected to serial neurologic examinations. On the 7th day, the dogs were killed, the sciatic nerves were excised, and histologic examination was performed by pathologists blinded to the purpose of the study. Results Whereas all perineural injections resulted in pressures ≤4 psi, the majority of intraneural injections were associated with high pressures (25-45 psi) at the beginning of the injection. Normal motor function returned 3 hours after all injections associated with low injection pressures (≤11 psi), whereas persistent motor deficits were observed in all 4 animals having high injection pressures (≥25 psi). Histologic examination showed destruction of neural architecture and degeneration of axons in all 4 sciatic nerves receiving high-pressure injections. Conclusions 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.

Pterygopalatine fossa represents very important topographic area, which is connected, by numerous foramina and fissures, to the other extracranial and intracranial areas. This gives to it huge anatomic and clinical significance. In these papers, through the method of computed tomography in axial and coronal projections, we have presented pterygopalatine fossa and the communications that it can establish through foramen rotundum (the middle cranial fossa), inferior orbital fissure (orbital cavity), sphenopalatine foramen (nasal cavity), greater palatine foramen and lesser palatine foramina (oral cavity), canalis pterygoideusa (nasal part of throat) and pterygopalatine fissure (infratemporal fossa). Knowledge on pterygopalatine fossa, and its communications, too, is necessary for adequate evaluation of the infective and tumourous processes, by which it might be primarily or secondarily taken.

Objective: In recent years regional anesthesia has gained great popularity. However, like any other medical procedure, the regional anesthesia carries certain risk of unintended intraneural injection and consequential neurological complications. Studies in animals have suggested that intraneural application of local anesthetics may cause mechanical injury. Previous studies, however, have used small animal models and clinically irrelevant injection speed or equipment. In this study we used equipment and injection methods in common clinical use to study the consequences and pressure dynamics of intraneural injection. Our hypothesis is that an intraneural injection is heralded by higher injection pressure and leads to neurologic impairment in pigs. Materials and Methods: Ten pigs of mixed breed (21-26 kg, 4-6 months old) were studied. After general anesthesia, the sciatic nerves (n = 20) were exposed bilaterally. Under direct vision, a 25-gauge insulated nerve block needle was placed either intraneurally (n = 10) or perineurally (n = 10), and 4 ml of preservative-free lidocaine 2% was injected using an automated infusion pump (15 ml/min). Injection pressure data were acquired using an in-line manometer coupled to a computer via an analog-to-digital conversion board. After injection, the animals were awakened and subjected to serial neurologic examinations during next 7 days. Results: All perineural injections resulted in injection pressures below 40 kPa. In contrast, intraneural injections resulted in significantly higher peak pressures (P < 0.01). In seven (70%) intraneural injections, the injections pressures were over 140 kPa (140-350 kPa). Neurologic function returned to baseline within 24 hours in all sciatic nerve receiving perineural injections. In contrast, residual neurologic impairment was present in seven sciatic nerves after intraneural injection and was associated with injection pressures >140 k Pa. Conclusion: High injection pressure (>140 kPa) predicts intraneural injection and consequential neurologic deficit. As long as the injection pressure is low, injection into poorly compliant tissue can be avoided and neurological complication can be prevented.