Der Unfallchirurg
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During the war in Croatia, 77 wounded with colon (64) and rectum (13) injuries were treated at Osijek Hospital in the Department of Surgery from June 1991 to September 1992. Shrapnel wounds accounted for 68.8% of the injuries. Forty-seven (61.0%) had unilocular penetrating injury, 15 (19.5%) had multilocular penetrating injuries, 10 (13.0%) had crush injuries, and 5 (6.5%) had contusion of the colon. ⋯ Primary repair was possible for 7 (9.1%) injuries, while 4 (5.2%) were repaired and extraperitonealized, 19 (24.6%) exteriorized injuries, 17 (22.1%) were resected followed by oral derivation, 21 (27.2%) sutured followed by oral derivation, and 6 (7.8%) had resection and anastomosis. In 3 (3.9%) patients no colon repair was performed as they died on the table. We had 13 (16.9%) complications and 14 (18.2%) mortalities, 11 (14.3%) postoperatively including 9 within the first 24 h after surgery.
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Case Reports
[Bilateral anterior shoulder dislocation fracture after an epileptic seizure. A case report].
Fractures can occur during violent muscular violence such as occur in the course of epileptic seizures, though this is rare (0.3%). The proximal part of the humerus is most frequently affected. ⋯ The treatment given was open reduction, refixation of the anterior labrum and screw fixation of the fragments. A review of the literature revealed only 18 cases of bilateral anterior dislocations caused by convulsive seizures.
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Foreign body embolisms can be traumatic and iatrogenic. Traumatic foreign body emulsion are almost always induced by gunshot wounds. Central vessels with a large lumen are the most frequent site of entry. ⋯ Treatment is dependent on the clinical signs and on size and shape of the foreign body. Symptomatic foreign body embolism and large irregularly shaped foreign bodies should be extracted. When only a small foreign body with no clinical symptoms is present conservative management is most appropriate.
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During the war against Croatia in 1991-1992, 85 wounded with war injuries of major vessels in the extremities were admitted to the Department of Surgery, Osijek Clinical Hospital. These 85 included 13 (15.3%) wounded with injuries of the popliteal artery. ⋯ Two amputations had to be performed because of massive soft tissue destruction and infection in the leg tissue. Our experience shows that an allograft is an acceptable choice for popliteal artery reconstruction in a highly contaminated war wound.
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Resuscitation and management of high-risk multiple trauma patients require a systematic and coordinated approach to diagnostic and therapeutic interventions. Clinical algorithms with branch chain decision logic can provide a clear and organized transformation of clinical standards for trauma care. Owing to their capability in formalization and standardization, algorithms define precisely the process of care and serve as a central interface within the system of quality assurance and quality control. ⋯ Special starting and ending point symbols make it possible to break down complex processes in several single interrelated algorithms. Inclusion of optional criteria checklists reduces the number of decision nodes and loops and minimizes the extent of a comprehensive algorithm. Clinical algorithms are an excellent tool for converting highly complex concepts of multiple trauma management into a logical, prioritized and systematic process of care.