[Hemorrhagic shock].

Hemorrhagic shock is a condition produced by rapid and significant loss of blood which lead to hemodynamic instability, decreases in oxygen delivery, decreased tissue perfusion, cellular hypoxia, organ damage and can be rapidly fatal. Despite improved understanding of the pathophysiology and significant advances in technology, it remains a serious problem associated with high morbidity and mortality. Early treatment is essential but is hampered by the fact that signs and symptoms of shock appear only after the state of shock is well establish and the compensatory mechanisms have started to fail. The primary goal is to stop the bleeding and restore the intravascular volume. This review addresses the pathophysiology and treatment of haemorrhagic shock.

[Total gastrectomy in the surgical treatment of acute massive hemorrhage caused by Dieulafoy lesion of the gastric fundus].

GI bleeding caused by Dieulafoy lesion in the gastric fundus: a case report Dieulafoy lesion is a rare cause of massive gastrointestinal (GI) hemorrhage that can be fatal. It arises from an abnormally large eroded submucosal artery and in more than 75% of cases the lesion is mostly found within 6 cm of the cardia. The severity of bleeding and the site of the lesion render the diagnosis sometimes difficult, more than one endoscopic exam is often required. Surgery was regarded as the treatment of choice in the past, but recently endoscopic management has become the standard approach. We report a case of an 42-year-old man presented with upper GI hemorrhage. Repeated upper GI endoscopies revealed a missed diagnosis of subcardial gastric ulcer and Mallory-Weis lesion. Following conservative treatment, the frequency and amount of haemorrhage decreased and totally stop. 48 hours after admission patient developed sudden massive upper GI bleeding and underwent emergency total gastrectomy. The diagnosis of Dieulafoy lesion was made histologically. The patient recovered uneventfully and discharged on the postoperative day 11th. Therefore, Dieulafoy disease represent a diagnostic and therapeutic challenge. Advances in endoscopic technique have greatly assisted in earlier diagnosis and added options to the treatment regimen for this lesion. The relationship of this anomaly to possible exsanguination makes it essential that both endosopical and surgical approach play an important role in the management of this pathology.

[Modern aspects of shoulder injury treatment].

The article describes injuries of soft and bone structures of the shoulder region, with special emphasis on the following clinical forms: instabilities and luxations of the glenohumeral joint, fractures of the proximal humerus, clavicle and the states of painful shoulder. Fractures and dislocations, but also significant entities - painful states caused not only by fractures but also by minor trauma such as tendinitises and m.supraspinatus tendon and bicipital tendon ruptures are discussed in more detail. Moreover, their consequences - painful and stiff shoulder - as well as modern diagnostic and therapeutic procedures applied in the painful shoulder treatment are also discussed.

[Anterior cruciate ligament (ACL)].

The anterior cruciate ligament or ACL (ligamenturn cruciatum anterius) is often injured, either alone or within complex ligament injuries of the knee. Therefore, the knowledge of detailed anatomic (macro- and micro-morphological) characteristics of this ligament is of key importance in therapy. The anatomy, structure, insertions, vascularization and inervation of the anterior cruciate ligament of the knee are described from the aspect of modern treatment and rehabilitation methods.

[Diaphragmatic rupture in present-day injuries]. / Ruptura dijafragme u savremenom traumatizmu.

In this report the authors took all material found on KBC Zemun for period from 1968 to 1988 on 43 causes traumatic rupture of diaphragms treated on this clinic. On their own experience and taking the experience of the others the authors found that: Traumatic rupture of diaphragm is a consequence of thoracoabdominal compressive trauma, which it accompanies in 3% of cases. Any traumatic rupture of diaphragm is an acute surgical state which requires an urgent surgical treatment. No other treatment is justified. Radiological method is applied in diagnosing the traumatic rupture of diaphragm. The surgical operation ought to secure a good detection of accompanying injuries. They are surgically taken care of by breaking the communication between the two cavities and, by providing their proper drainage. The major factor causing this type of traumatism presents the traffic accidents. The death rate with these traumas is very high and largely depending on accompanying injuries, reaching 20.9% in the material that we studied.