[Surgical treatment of liver injury--5-year experience].

Due to improved methods of treatment and management of hemorrhage, the mortality from liver injuries has decreased significantly over the past few decades. In spite of that, liver injuries still represent diagnostic and therapeutic challenge. This retrospective study included 197 patients surgically treated because of trauma of the liver at The Clinic for Emergency Surgery, during the period 2004-2009. The results showed significant difference in mortality rates in cases of penetrating wounds compared to blunt trauma and gunshot wounds. The severity of injury evaluated by Organ Injury Scale was significantly higher in gunshot wounds compared to blunt and penetrating trauma. The correlation of severity of injuries and mortality rates showed that the mortality is significantly lower in patients with grade 1, 2, and 3 injuries compared to grades 4 and 5 (p = 0.016). Specific complication rate was 28.4%, while mortality rate was 21.8%. The results reflect diagnostic and treatment problems, as well as the importance of multidisciplinary approach to the patients with liver trauma.

[Surgical treatment of pancreatic injuries in severe abdominal trauma].

In spite of its low incidence, pancreatic injuries hold important place in abdominal trauma because of diagnostic difficulties, severe potential complications, therapeutic challenges, and high mortality rates. These injuries are related with specific morbidity and are very often accompanied with injuries of other organs. This retrospective study included 31 patients treated at The Clinic for Emergency Surgery of Clinical Center of Serbia during the period of 2004-2009 with intraoperativelly confirmed diagnosis of pancreatic trauma. The most common mechanism of injury was blunt trauma (83.9%). Among available diagnostic methods, abdominal ultrasound was characterized with high incidence of false-negative findings (33.3%) while for CT it was at 16.6%. The type of surgical procedure was related to degree and severity of injury. Specific complications occurred in 22.6% of patients, while mortality rate was 25.8%. The creation of unambiguous algorithms for optimal treatment of patients with pancreatic trauma require multi-centric prospective studies.

[Laparoscopy in the evaluation of blunt abdominal trauma].

Laparoscopic diagnostics provides fast, reliable, clear, and obvious information on extent and depth of abdominal organs injury with minimizing additional trauma to the patient. It is performed without any specific preparations and, if needed, it may be promptly converted into conventional laparotomy. Through use of optical equipment with various refraction angles and through variable patient positioning, laparoscopic technique enables visualization of whole abdominal cavity. In approximately 20% of cases of unclear findings, and after other performed diagnostic procedures, laparoscopy provides definitive diagnosis. Abdominal surgeons are familiar with this method, making interpretaion of the results very fast and reliable and, what is the most important, this method avoids additional trauma caused by conventional laparotomy.

[Abdominal compartment sydrome in trauma patients].

Intra-abdominal compartment syndrome (ACS) are increasingly recognised to be a contributing cause of organ dysfunction and mortality in critically ill patients. The term abdominal compartment syndrome (ACS) describes the clinical manifestations of the pathologic elevation of the intra abdominal pressure (IAP). This syndrome is most commonly observed in the setting of severe abdominal trauma. ACS affects mainly the respiratory, cardiovascular, renal, gastrointestinal and central nervous system. Preventing ACS by the identification of patients at risk and early diagnosis is paramount to its successful management. Because of the frequency of this condition, routine measurement of intra abdominal pressure should be performed in high risk patients in the intensive care unit. Surgical decompression is definitive treatment of fully developed abdominal compartment syndrome, but nonsurgical measures can often effectively affect lesser degrees of IAH and ACS.

[Oversights in the care of severe injuries].

Question of missed injuries is more often a question of human errors: task execution errors, procedural errors, communication errors, decision errors and noncompliance. Missed injuries are those which are not idetified in the first three days of hospitalisaation. This theme is not popular among physicians. Literature data mention percent from 3-29% missed injuries overall. The underlying causes errors are: false attributin, false negative prediction and false lebeling. False attribution involves a tendency to incorrectly link a clinical observation with an arroneous cause. This tendency also ignores one of the fundamental principles of the management of traumatic injury: that the index of suspicion should proceed on the basis of assumed wors resonable case scenario. Weaknesses of trauma systems: high patients volume, high-risk patients, long hours, changing set of resources, and problems sush bad admission planing, defficite anamnesis, defficite diagnostic procedures, bad communication, improvisation etc.

[Transfusion practice in trauma patient].

Anemia is common in critically ill patients and carries risk of reduced oxygen carriage and worse outcomes. Transfusion, however, carry their own risk, and the physician must balance the risks of anemia with the risk of transfusion in each patient. Some recent studies compared a liberal with a restrictive approach to transfusion, and a clinical practice guidelines were made. This protocols consider that acute hemorrhage has been controlled, the initial resuscitation has been completed, and the patient is stabile in the intensive care unit without ongoing bleeding. The trigger for PRBC transfusion in patients without severe cardiovascular disease is hemoglobin g/dL (or a hematocrit %).

[Relation between cytokine IL-6 levels and the occurrence of systemic complications in patients with multiple injuries and blunt abdominal trauma]. / Odnos nivoa citokina IL6 i ucestalosti sistemskih komplikacija kod politraumatizovanih sa tupom abdominalnom traumom.

Severe trauma is the third cause of death and the first one in the most vital and young population. In USA more children die of trauma then of all other causes. Blunt abdominal trauma takes 56% cases of multiple traumas of all etiologies. Among multiple injured patients, near to 50% have some system-complications, more of 60% in the group of critically injured (ISS > 35). Cytokines play the main role in the inflammatory reaction during the early phase response on trauma. Their secretion predicts system-complications as ARDS, SIRS, even MODS. Hypothetically, level of concentration of Interleukin-6 (IL 6) can improve methods of early diagnostic procedures for detecting SIRS and MODS, when scores are still low (preclinical level), at which stages therapy is more powerful and also cheaper. This prospective study includes 35 multiple injured persons with blunt abdominal trauma (75 > ISS > 18). We have used standard diagnostic procedures. Concentration of IL 6 was detected with ELISA-test. Levels of IL 6 were significantly higher in correlation with SIRS score groups. Correlation with MODS score was not significant for the lowest scores, but IL 6 showed significant higher levels in the second and the third MODS score group.