Ultrasonography in the evaluation of hemoperitoneum in war casualties.

The aim of this study was to evaluate the sensitivity, specificity, accuracy, and positive and negative predictive values of emergent ultrasound examination in the detection of hemoperitoneum among war casualties, and to compare the results of this method in a specific war situation and civil conditions. Ninety-four wounded individuals with suspected blunt or penetrating abdominal trauma were treated at a level I war hospital (group W), and 242 civilians with multiple injuries with suspected blunt abdominal trauma were evaluated at the emergency center of a university hospital (group C). All examinations were performed in less than 5 minutes with a portable ultrasonographic scanner, and typical points were scanned (Morison's pouch, Douglas and perisplenic spaces, paracolic gutter). In group W, hemoperitoneum was identified correctly in 19 patients, with three false-negative and no false-positive findings, whereas group C presented 98 true-positive results, 13 false-negative results, and again no false-positive results. We observed that ultrasonography in specific war conditions showed sensitivity of 86%, specificity of 100%, accuracy as high as 97%, positive predictive value of 100%, and negative predictive value of 96%, whereas in civil conditions the corresponding values were 88%, 100%, 95%, 100%, and 91%, respectively. The sensitivity, specificity, accuracy, and positive and negative predictive values of emergent ultrasound examination in the diagnosis of hemoperitoneum are approximately equal in war and civil conditions.

[Emergency surgical conditions after kidney transplantation]. / Hitna kirurska stanja nakon transplantacije bubrega.

During the period from 30. 01. 1971 to 30. 03. 1988 403 kidney transplantations were performed on the Surgical clinic KBC and Medical faculty at Rijeka. Satisfactory results were achieved concerning surviving of patients and grafts. Emergency vascular complications leads to lost of graft in most cases. Urologic complications less affecting the graft but because of possible infection could jeopardize the life of patient. In the surgical treatment of urological complications recipient ureter was used in most cases and in two patients isolated ileal loop. Among gastrointestinal complications bleeding from gastroduodenal ulcer was the major problem. After onset of routine use of antagonists of histamine H2 receptors those complications has been reduced from 6.6% to 1.5%. In five patients a spontaneous rupture of graft has happened. In two patients direct suture of rupture saved the graft. All our activities with the patients after kidney transplantation should be in careful treatment and early recognition of complications and aggressive surgical approach when it is necessary.