In relation to the immediate management of patients injured by explosive weapons, it follows that particular attention should be paid to the presence and/or development of blast injury. Our findings indicate that blast is more common in war injuries than previously thought. Eicosanoid changes after blast injury suggest that blast injury causes a major physiologic stress. A variety of effects on the central nervous system suggest that blast injury could be responsible for some aspects of what is now considered to be the posttraumatic stress disorder.
Background/Aims. Thyroid gland surgery today is not saddled with high incidence of main complications. Miscellaneous surgical institutions with different surgical approach, operative technique and radicality have published reports with great discrepancy in incidence of complications, analyzing them with different methods of diagnosis and result evaluation. In the same way it is well known that higher latitude of operative procedure gave better control of thyroid diseases, but it can be accompanied with more complications. All of that motivate us to analyze complications of operative treatment in our patients under well known criteria, with hypothesis that higher radicality of operative procedure do not increase incidence of complications, and that this incidence is in correlations with results published in world literature. Aim of this nonrandomized study was to analyze results of operative treatment for huge number of consecutively operated patients in our teaching hospital, to analyze and compare results according to group of diseases and operative procedures, and to compare final results with results published in the world literature. Methods. Complications of operative treatment were analyzed retrospectively for period 1988-1997 (Group I) and prospectively in period 1998-2002 (Group II). Operations were performed by 20 surgeons and 20 young surgeons during their education. We have analyzed only complications during first 30 days after operation. Results. In Group I there was 1425 patients with 1451 operations (192 thyroid malignances, 247 hyperthireosis, 98 reoperations, 13% thyreoidectomies and 14,8% lobectomies), with complication rate of 14,3%. Most common complication was recurrent laryngeal nerve injury in 9,3% patients or 6,3% according to number of exposed nerves („nerve at risk“), then postoperative hypocalcemia with rate of 4,7% (persistent in 1,3%). In Group II in 675 patients there was 687 operations (96 thyroid malignances, 111 hyperthireosis, 35 reoperations, 36,6% thyreoidectomies and 25% lobectomies), with complication rate of 10,7%. Most common postoperative complication was hypocalcemia with 5% rate (persistent in 0,7%), then recurrent laryngeal nerve injury in 4,4% patients or 2,9% according to number of exposed nerves („nerve at risk“). Incidence of recurrent laryngeal nerve injury in Group II is less frequent than in Group I, highly statistically significant (p<0,01), while for other complications there is no statistically significant difference. Totally for both groups there was 0,7% tracheotomies, postoperative bleeding in 1,1% of patients, wound haemathoma in 0,5%, wound infections in 0,9%, pneumonia in 0,5%, mortality 0,5% and most common cause of death (8/11) was problem with respiration, „Airway obstruction“. In Group II complications were less frequent in total thyreoidectomies in relation to lobectomy with contra lateral subtotal lobectomy. In both groups and totally incidence of complications was higher in reoperations, in patients with more extensive operative procedure, in ma...
Peritoneal lavage cytology was shown to be a useful tool for the detection of the group of patients with greatest risk of peritoneal dissemination. The frequency of positive cytological findings was highly associated with the diameter of the tumor and the cancer invasion of serosa. Cytological examination of peritoneal lavage fluid improved the accuracy of staging and selection of patients who might have benefit from neoadjuvant chemotherapy.
Authors presented their own experiences in treating 735 wounded in high-intensity combat zones in the territories of former Yugoslavia during 1991 to 1992. The mobile field hospital with surgical crews was situated 5 to 10 km from the front line, and its basic task had been continuous triage, immediate resuscitation with vital surgical aid, as well as organization of adequate primary and secondary air evacuation. At the field hospital level, fresh wounds were explored according to principles of war surgery, and major surgical interventions were performed in 3.3% of the wounded. Patients with massive hematothorax were treated with autotransfusion. Mortality at this primary level, field hospital was 0.75% with primary immediate resuscitation and 1.9% with immediate evacuation. We concluded that immediate resuscitation with delayed transport had advantages, compared with fast evacuation of only the wounded.
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