The problems and characteristics of hepatic war trauma management in central Dalmatia during the 1991-1995 war in Croatia

OBJECTIVE: War injuries to the liver treated during the 1991-1995 war in central Dalmatia, Croatia, were analyzed retrospectively. METHODS: There were 713 patients with abdominal injuries, 125 (17%) of whom were operated on for liver injuries. Mobile surgical teams operated on 91 patients (73%) in rear war hospitals (echelons II and III); only 34 patients (27%) were immediately transferred to and operated on at the Split University Hospital. RESULTS: After wounds to the small and large intestine, liver injuries were the third most common abdominal injuries. Morbidity was 63%, and reoperations were required in 20% of cases. Fourteen patients (11%) died. The highest rate of complications was observed in patients with postoperative inflammatory intra-abdominal collection, disseminated intravascular coagulation, adult respiratory distress syndrome, sepsis, or ileus. The highest mortality was found in those patients requiring a right hemihepatectomy. CONCLUSIONS: The best results were achieved in patients on whom, after hepatotomy, selective hemostasis with liver debridement was carried out.     

Osijek Health Center during the 1991-1992 war in Croatia

To assess the effectiveness of health services in the city of Osijek during the 1991-1992 war in Croatia, we followed the changes in the utilization of health services, morbidity and mortality, and completion of a vaccination plan during the 2 years of the war. We used a retrospective analysis of data from the Osijek Health Center and the Osijek County Institute of Public Health. The organization of health care during the war followed the concept of integrated health care and the instructions of the Ministry of Health. Visits to primary health care physicians decreased considerably, with a concomitant increase in disease and mortality. The plan for mandatory vaccination was not completed because of the evacuation of preschool and school children. The war changed the mode of health care use, the disease and mortality structure, and the implementation of mandatory vaccination. However, timely education and preparation of the health services to the war situation resulted in an adequate provision of health care to the population.     

Evacuation times of civilians and soldiers wounded during the war in Croatia

OBJECTIVE: The goal of this study was to estimate the mean time needed for evacuation of wounded persons from the site of injury to a medical institution. METHODS: A database that includes medical and demographic data for persons treated in Croatian hospitals during the 1991-1995 war in Croatia was used. RESULTS: A total of 61.11% of wounded persons was evacuated within 1 hour. The mean evacuation time was 2.26 hours, and times for civilians and army units did not vary significantly. After wounded patients were admitted to medical institutions, the chances of survival were 98.36%. CONCLUSION: Because the wartime medical system in Croatia depended on army units for transport and on civilian medical institutions for medical procedures and later care, we conclude that the integrated model of medical care led to short evacuation times, with no significant differences between soldiers and civilians or soldiers on the two sides.     

Military casualties in Baranja and east Slavonia during the first 9 months of the war in Croatia.

The total number of Croatian Army soldiers killed in the period from the beginning of July 1991 until the end of March 1992 was 487. The number of severely wounded was 1,160, and 1,141 soldiers were slightly wounded. The ratio of the killed to wounded was 1:5, except in the municipality of Osijek, where it was 1:2.5. The number of casualties increased continually and culminated during November 1991, the period of fiercest fighting in this territory, followed by a gradual decrease. The most common mechanism of injury was explosives, which were responsible for almost half of all casualties (47.9%). An equal number of soldiers were killed by explosives and infantry weapons (46.4% and 44.9%, respectively). Casualties caused by motor vehicle crashes are not to be ignored, especially after the cease-fire agreement. Car crashes frequently resulted in death (from 4.5%-12.4%).     

Dental identification of war victims from Petrinja in Croatia

In this paper the authors report their experiences and problems encountered in the identification of war victims from Petrinja in Croatia. Soon after Croatian forces regained Petrinja in 1995, four mass graves were discovered from which the bodies of 46 civilians, 38 males and 8 females, were recovered. Identification of the victims was performed at the Department of Forensic Medicine and Criminology at the School of Medicine in Zagreb. A forensic odonto-stomatologist from the Department of Dental Anthropology of the School of Dental Medicine at the University of Zagreb participated in the identification process by carrying out dental identifications. A total of 27 victims (59%) were identified, while 19 (41%) are at present still unidentified. Identification by supportive and anthropological evidence (e.g. sex, age, height, personal documents, dress, jewellery) was achieved in 43% of cases, while identification based only on dental records was achieved in 16%. The most useful dental characteristics for the purpose of identification were fixed and removable prosthetic appliances for oral rehabilitation. The reason for the low number of dental identifications was the lack of antemortem dental data which could be compared with postmortem dental records. Received: 11 April 1996 / Received in revised form: 25 November 1996     

Acute myocardial infarction during adenosine myocardial perfusion imaging

Journal of Nuclear Cardiology -     

Characteristics of heart rate variability in war veterans with post-traumatic stress disorder after myocardial infarction

OBJECTIVE: The goal of the study was to evaluate differences in heart rate variability (HRV) among post-myocardial infarction (MI) patients, depending on their participation in the Croatian war and on established diagnoses of post-traumatic stress disorder (PTSD). METHODS: The study included 34 male war veterans with diagnosed PTSD who had suffered a first MI and 34 age-matched post-MI patients without PTSD. Cardiac autonomic balance was evaluated through HRV analysis. RESULTS: There were no differences in the mean R-R interval or overall HRV between the analyzed groups. Post-MI patients with PTSD had lower values for the square root of the mean of squared successive differences in R-R intervals (p = 0.02), the percentage of R-R intervals that were > or =50 milliseconds different from the previous interval (p = 0.03), and the high-frequency component (p = 0.03) but had higher values for the low-frequency component (p = 0.01) and the low-frequency/high-frequency ratio (p = 0.02), compared with post-MI patients without PTSD. CONCLUSION: Post-MI patients with PTSD have higher sympathetic and lower parasympathetic heart rate modulation activity, compared with patients with MI and no PTSD.     

Injuries caused by antipersonnel mines in Croatian Army soldiers on the East Slavonia front during the 1991-1992 war in Croatia

During the war in Croatia, antipersonnel mines were mostly laid without plan by both sides, with no minefield layout, especially on the East Slavonia front. A group of Croatian disabled war veterans wounded by antipersonnel mines at the East Slavonia front from June 1, 1991, to September 1, 1992, were analyzed. The front line between the Croatian Army units and Serbian paramilitary units mostly ran along a lowland, partially swampy and wooded ground, convenient for large-scale laying of antipersonnel mines, especially so-called surprise mines. Fifty-seven soldiers suffered injuries caused by antipersonnel mines, 27 (47.4%) of them by pressure-activated mines and 30 (52.6%) by pull-action mines. The severity of wounds was assessed according to the Abbreviated Injury Scale (AIS). In the group of patients with wounds inflicted by pressure-activated mines, the mean AIS score was 4.0 +/- 0.7, with injuries to the lower extremities (mostly feet) ranging from foot-mutilating defects to partial lower-leg amputation. In the group of patients with injuries caused by pull-action mines, the mean AIS score was 3.0 +/- 0.9, indicating relatively minor injuries of different types according to the mechanism of wounding and localization. A failure to comply with minelaying regulations made protection impossible and resulted in a relatively high proportion of the wounded. The same problems are now encountered on mine removal. According to estimates, at least 10 years of intensive work of 2,000 to 3,000 trained experts will be required to clear some 2 million mines laid all over the area.     

Dermatomycosis, hyperhydrosis, and mechanical injury to skin of the feet in Croatian soldiers during war in Croatia 1991-1992

During the War in Croatia from 1991 to 1992, we conducted an epidemiological study of the most frequent skin changes on the feet of 1,702 Croatian soldiers stationed in trenches and exposed to direct war activities. We saw significant increases in dermatomycosis, hyperhydrosis, and mechanical injury to the skin of the feet. Soldiers involved in this study did not have any specific medications or powders available as standard gear to prevent any of these foot diseases, but upon physical examination they received treatment. We can conclude that, in war situations, conditions are sufficient to cause an increased number of dermatomycosis, hyperhydrosis and chronic mechanical injuries of the foot. This study suggests the need for planned prevention to avoid these foot diseases in combat situations.     

急性心肌梗死时伴恶心呕吐的临床意义探讨

目的探讨急性心肌梗死(AMI)时伴恶心、呕吐的临床意义。方法选取AMI患者152例,根据是否存在恶心、呕吐症状,分为研究组及对照组,对比分析两组患者的临床资料。结果研究组的TNI、CKMB、BNP测量峰值以及心律失常、心力衰竭、心源性休克发生率和住院死亡率均较对照组高(P<0.05)。结论心源性呕吐是AMI患者梗死面积大、并发症多、病死率高的重要预测指标。     

Intervention in acute myocardial infarction

The role of thrombolytic therapy in decreasing mortality and improving left ventricular function has been well established. The role of secondary PTCA is still being defined. Current data support a strategy of performing coronary angiography and elective PTCA only in patients with evidence of ischemia after thrombolytic therapy. Despite the trend away from routine early invasive therapy for acute myocardial infarction, accurate definition of coronary anatomy and assessment of left ventricular function will continue to be vital in the management of these patients and provide a continuing challenge for the cardiac radiographer.     

老年心肌梗死患者在疗养期间的心理护理

心肌梗死（myocardial infarction）即心肌缺血性坏死，是在冠状动脉病变的基础上，发生冠状动脉血供急剧减少或中断，使相应的心肌严重而持久地急性缺血坏死所致。该病在老年人中的发病率和病死率高，且合并症多，严重威胁老年病人的生命。近几年，在疗养院此类病人的发病率和抢救率也在明显升高，     

Exercise tolerance and compensatory sympathetic tone during beta-blockade after myocardial infarction

Using chronically instrumented dogs with a healed anterior wall myocardial infarction, we have assessed the effect of acute beta-adrenergic blockade on exercise tolerance, left ventricular (LV) performance, and myocardial VO2. Mongrel dogs were instrumented with Doppler flow probes around the left circumflex coronary artery, LV pressure cells, epicardial ECG electrodes, and left atrial and coronary sinus catheters. Myocardial infarction was produced by ligation of the left anterior descending coronary artery at time of instrumentation (approximately 20% LV mass). After a 1-month recovery period, dogs were subjected to two identical submaximal graded exercise tests on a treadmill on separate days, once without (control) and once with (propranolol, 1 mg X kg-1, i.v.) acute beta-adrenergic blockade. Heart rate, LV pressure, dP/dt max, left circumflex blood flow velocity, and myocardial VO2 index were measured at each stage of the graded exercise test. All variables were significantly reduced from control during beta-block in exercise. beta-Adrenergic blockade in the presence of a 1-month-old anterior wall myocardial infarction did not compromise exercise capacity during submaximal exercise.     

Radionuclide evaluation of left ventricular synergic pumping efficiency during acute myocardial infarction

The clinical value of an index of left ventricular synergic pumping efficiency (EFF) was evaluated in 50 patients with uncomplicated myocardial infarction in which radionuclide ventriculography was performed within 72 h of the onset of the infarction and between 7 and 13 days post infarction. EFF was defined as the ratio of global left ventricular stroke volume to the magnitude of all intraventricular blood pool variations measured on a pixel by pixel basis. EFF correlated better with a subjectively evaluated wall motion index (r = 0.84) than did the ejection fraction (EF) measurements (r = 0.69). In all patients, but most significantly in patients with inferoposterior infarctions, EFF measurements in the acute phase were a better predictor of the predischarge ventricular performance than the EF measurements. The left ventricular EFF is a reliable parameter to quantitate the effect of regional wall motion disturbances on global ventricular function in a standardized manner.     

用双核素心肌断层显像评价Q波和非Q波心肌梗死存活心肌

目的利用^99Tc^m-甲氧基异丁基异腈(MIBI)/^18F-脱氧葡萄糖(FDG)双核素心肌断层显像评价Q波和非Q波心肌梗死(MI)患中存活心肌的情况。方法45例MI患分为无Q波MI(NQMI，n=17)和有Q波MI(QMI，n=28)2组。均行^99Tc^m-MIBI SPECT门控心肌灌注显像、^18F-FDG SPECT心肌代谢显像和冠状动脉造影。根据心肌血流灌注、代谢和门控信息等比较2组患存活心肌的情况。结果NQMI组的缺血存活心肌节段数明显高于QMI组，非存活心肌节段数明显低于QMI组(P值分别为0．001和0．005)；左室射血分数(LVEF)明显高于QMI组(t=4．603，P：0．000)。门控分析所得室壁增厚率和缺血存活心肌间存在良好相关性(r=0．671，P=0．000)，NQMI组室壁增厚率降低的节段数明显低于QMI组(t=4．183，P=0．000)。结论对NQMI患采取更积极的治疗策略有助于挽救更多的缺血存活心肌，改善其预后。