[show abstract][hide abstract] ABSTRACT: The aim of our study is to evaluate results of treating war injuries of colon and rectum, after 10 years. During the war in Croatia, 21 wounded, with colon (19) and rectum (2) injuries, were treated in the Department of Surgery at Nova Gradiska General Hospital from August 1991 to April 1992. Bullet wounds accounted for 57% of the injuries. All patients had other associated injuries. Primary repair and proximal derivation was possible in 2 cases (9.5%), while primary resection with intraperitoneal anastomosis was performed in 3 (14.3%) patients. In 2 (9.5%) patients sustained intraperitoneal and extraperitoneal rectal penetrating injury rectum was resected and closed performing temporary sigmoidostomy. When multiple perforations or crush injury of the colon were found, in 8 (38.1%) injured persons resection of the involved segment was combined with proximal end colostomy and aboral mucous fistula. Exteriorization of injured segment of the colon and creating colostomy incorporating the injured colon as the stoma was performed in 6 (28.5%) wounded patients. Four of the wounded (19.0%) died two of them during the operative procedure due to hemorrhagic shock. One injured died after eight days due to pulmonary embolism, and one patient died after thirty days due to sepsis. Reoperation was necessary in two (9.5%) injured due to bowel obstruction four days following initial surgery because of adhesions. Three (14.3%) of the injured had wound infection, one of them died 30 days after injury due to sepsis, and two (9.5%) consequently developed ventral hernia that was operated after 4 and 5 years respectively. Four (19.0%) of the injured are still occasionally experiencing occasional abdominal pain.
Collegium antropologicum 01/2003; 26(2):441-6. · 0.61 Impact Factor
[show abstract][hide abstract] ABSTRACT: The present report summarizes the experience of an evacuation hospital in southern Croatia in treating 96 patients with spine and spinal cord war injuries.
A retrospective review was done for 96 wounded persons (86 soldiers, 10 civilians) with spinal cord injuries from August 1991 through December 1995. The ages ranged from 15 to 59 years (mean, 28.3 years for soldiers, 38.5 years for civilians). Diagnostic procedures were plain radiography, computed tomography, and computed tomographic myelography. However, in most cases a more conservative surgical approach was used.
The highest rates of admittance were recorded in 1992 (N = 38) and 1993 (N = 47). The lumbar spine was injured in 55% of the patients, the cervical and thoracic spines in 17.7%. All injuries were caused by projectiles from automatic rifles and sniper fire (51%) and from fragments of explosive devices (49%). Blast injury of the spinal cord was found in 10 patients. The most frequent complications caused by the fragments were wound infection, urinary tract infection, decubitus, and pneumonia. Four patients (4.2%) died in the hospital, and 43.0% of patients survived but were severely handicapped.
Careful clinical examination combined with modern diagnostic imaging and use of broad-spectrum antibiotics reduced the need for surgical intervention in patients with spinal cord injuries.
Military medicine 01/1999; 163(12):847-9. · 0.77 Impact Factor
[show abstract][hide abstract] ABSTRACT: In this study, we review the initial clinical and radiological management and early outcomes of 14 patients with orbitocranial war injuries treated at the University Hospital Split between 1991 and 1995.
This investigation involves 14 patients (13 soldiers and 1 civilian) with orbitocranial war injuries. The mean patient age was 31 years (range, 23-54 years). The penetrating object was a metal shrapnel fragment in 8 patients and a bullet in 6 patients. The results of clinical and radiological management were retrospectively analyzed.
The mean time from the moment of wounding to hospital admission was 6 hours (range, 1-30 hours). The mean Glasgow Coma Scale score was 8 (range, 3-14). Craniotomy was the basic neurosurgical procedure, and three patients were treated with simple scalp wound debridement and closure. Osteoplastic operations of the orbital bones were performed in 13 patients. Enucleation/evisceration was performed in 6 patients (42.8%). At discharge, the mean Glasgow Outcome Scale score was 13, and 1 patient died in the hospital. Blindness (including amaurosis and anophthalmus) was present in nine eyes (8 patients), light-perception positivity and projection positivity were present in four eyes, and visual acuity was at 0.1 in 1 patient.
An early multidisciplinary therapeutic approach and computed tomography as a diagnostic procedure are necessary for a good result in the treatment of orbitocranial war injuries.
Military medicine 08/1998; 163(7):490-3. · 0.77 Impact Factor
[show abstract][hide abstract] ABSTRACT: During the war in Croatia, from August 1991 until December 1994, 138 soldiers were treated at the Split University Hospital for different brain injuries inflicted by missiles. Nine of these 138 patients developed intracranial infection. This retrospective study reports on the outcome of these 9 intracranial infections caused by penetrating missile head injuries. In case of clinically suspected infection, computerized tomography scan was obtained at two time points during the course of infection in the same patient. Scans were obtained with and without contrast media, 7 to 14 days after the injury and the 4 weeks later. The role of computerized tomography in the detection and follow-up of various intracranial infections and long-term consequences were evaluated.
Acta medica Croatica: c̆asopis Hravatske akademije medicinskih znanosti 02/1997; 51(4-5):233-7.
[show abstract][hide abstract] ABSTRACT: The surgical approach to liver echinococcosis is still a controversial issue. This study shows our results of surgical treatment of liver hydatid cysts during a 5-year period.
A prospective study of 21 patients operated on in a 5-year period (1999-2003), in Dubrava University Hospital in Zagreb, Croatia, with hepatic hydatid cyst. All patients were pre-operatively treated with albendazole. In 12 patients, total pericystectomy without opening the cyst cavity was performed, 9 open and 3 laparoscopic. In the other 9 patients, partial pericystectomy was done, 6 open and 3 laparoscopic.
There was no mortality after 5-65 months follow-up, but in 1 patient, in the open partial pericystectomy group, recurrence of the disease occurred after 3 years. When a laparoscopic procedure was done, there were no complications or recurrence. The median operative duration for open surgery was 100.0 min (range 60.0-210.0), and for laparoscopic surgery 67.5 min (range 60.0-120.0). The median length of hospitalisation for open surgery was 8.0 days (range 7.0-14.0), and for laparoscopic surgery 5.0 days (range 4.0-7.0).
Total pericystectomy without opening the cyst cavity, preceded by pre-operative albendazole therapy is the method of choice for hepatic hydatid cyst treatment. Despite the small group of patients, our first results show laparoscopic total pericystectomy without opening the cyst cavity, in the treatment of hepatic hydatid cyst, as a good alternative to open surgery in selected patients.