War head injury score: an outcome prediction model in War casualties with acute penetrating head injury.

OBJECTIVE: To evaluate in war casualties with acute penetrating head injury whether the summed War Head Injury Score (WHIS) is a better predictor of mortality than either the Glasgow Coma Scale (GCS) score or the Injury Severity Score (ISS) alone and to establish its specific applicability. METHODS: Sensitivity, specificity, correct outcome prediction, and discrimination were assessed in 43 patients in the war group (ballistic injuries) and 41 patients in the civil group (nonballistic injuries) during the period 1991 to 1995. The new model was generated using the sum of GCS scores and ISS, to which a coded value was applied for summation. RESULTS: In the war group, the mortality rate was 23%; the sensitivity and specificity of WHIS were 100% and 79%, the sensitivity and specificity of GCS score were 90% and 85%, and the sensitivity and specificity of ISS were 100% and 49%, respectively. In the civil group, the mortality rate was 39%; the sensitivity and specificity of WHIS were 87% and 76%, the sensitivity and specificity of GCS score were 63% and 90%, and the sensitivity and specificity of ISS were 100% and 56%, respectively. CONCLUSION: With regard to civilians, war casualties with acute penetrating head injury more often have multiple injuries. WHIS represents a new scoring system that incorporates both GCS score and ISS.

Ultrasound-guided percutaneous dilatational tracheostomy: a safe method to avoid cranial misplacement of the tracheostomy tube.

The aim of this investigation was to evaluate the role of ultrasonography in avoiding cranial misplacement of the tracheostomy tube and tracheal ring fractures during percutaneous dilatational tracheostomy (PDT). The tracheas of 26 consecutive ICU patients who had undergone PDT but who later died were removed en bloc at autopsy. The tracheas were opened along the membranous portion and the condition of tracheal rings and the site of tracheostomy macroscopically evaluated. The patients were divided in two groups: group A with 15 patients who underwent "blind" PDT and group B with 11 patients who underwent ultrasound-guided PDT. In five (33%) patients from group A, autopsy revealed that the tracheostomy tube was placed between the cricoid cartilage and the first tracheal ring (cranial misplacement) and in six (43%) patients a fracture of one tracheal ring was found. Cranial misplacement of the tracheostomy tube in patients from group B was not found (P < 0.05) and four (36%) patients had a broken tracheal ring (P = NS). The authors maintain that by using ultrasound-guided PDT cranial misplacement of the tracheostomy tube may be entirely avoided.

[Percutaneous tracheostomy]. / Perkutana traheostomija.

In the last few years numerous reports from intensive care units confirm that a nonsurgical percutaneous tracheostomy has successfully replaced elective conventional (surgical) tracheostomy. The majority of authors point out the advantages over surgical technique such as: the speed of procedure, the possibility of doing it at bedside thus excluding transport and the need for operating theatre, less infections around stoma, minor cosmetic defects and finally, more economical price. The article describes three, according to pertinent literature most often utilized techniques, i.e. percutaneous dilatation tracheostomy with dilators, percutaneous dilatation tracheostomy with forceps, and translaryngeal tracheostomy. Main differences, advantages and defects of each method are presented. Contraindications and eventual complications are discussed, as well as the utility of supporting methods for safer placement of tracheostomy tubes, such as endoscopy and ultrasonography.

New technique for processing paraffin-embedded tissue for Y chromosome fluorescence identification of trophoblastic disease.

A new reprocessing technique for Y chromosome fluorescent body (q 12 region) detection of trophoblastic disease in previously paraffin-embedded tissues is described. Deparaffinized sections were treated with pronase and trypsin for digestion, followed by hydrolysis with HCl and acetic acid, staining with quinacrine hydrochloride fluorochrome and mounting in Sørensen's phosphate buffer (pH 5.5). Use of the technique resulted in sufficient fluorescence quality and better accuracy for Y and X heterochromatin scoring. The technique yielded the same results in retrospective formalin-fixed, paraffin-embedded trophoblastic specimens as in fresh tissues. The combinations of enzymes and acids and the dosages necessary for optimal results are discussed.

[Histologic type and tumor maturity as prognostic factors in malignant epithelial tumors of the ovary]. / Histoloski tip i zrelost tumora kao prognosticki faktor kod malignih epitelnih tumora jajnika.

A retrospective pathological analysis of 664 patients with malignant ovarian epithelial tumors of coelom epithelium origin was performed. In 93 cases (14%) proliferative tumors were found. Out of the remaining 571 cases a group of 311 cases with the five-year survival in the period 1965-1980 was singled out (39.9% invasive and 98% proliferative tumors). The clinical staging of the illness is the most important prognostic factor. In the clinical stage I the five-years survival was 78.8%, the difference being statistically not significant in relation to the histological maturity of the tumors. For any further clinical stage the five-year rate of survival decreased by about 30%. In the clinical stages II, III and IV survival statistically significantly differed (p less than 0.01) with regard to the histological grade of maturity I, whereas the survival was almost the same in cases with moderately or poorly differentiated tumors. Regardless of the clinical stage of the illness, the five-year survival rate for histological grade I was 71.8%, for grade II 24.5% and for grade III 20.4%. According to the histological type of the tumors, the best prognosis is for mucinous cancers, where the five-year rate of survival was 51.4%, and the worst for undifferentiated (13.3%) and clear-cell cancers (16.7%).

[Pathohistologic difficulties in the diagnosis of proliferative ovarian cystadenoma]. / Patolosko histoloske poteskoce dijagnosticiranja proliferativnih cistadenoma jajnika.

The authors present 31 proliferative cystadenomatous tumours of the ovary discovered in the period from 1978 to 1981 and selected on the basis of the WHO classification: 10.4% of them were found among serous, 12.6% among mucinous, and 11.1% among seromucinous tumours.

Primary hypertrophic osteoarthropathy (PHO) and changes in the joints. Clinical, X-ray, scintigraphic, arteriographic and histologic examination of 19 patients.

Nineteen patients with PHO with onset in childhood are presented. In 7 cases the syndrome was found in other family members too. In clinical, X-ray scintigraphic, arteriographic, and plethysmographic investigations, joint affection was found in 14 patients. Clubbing of the fingers and toes was seen in all the patients and a periosteal reaction was found in the long bones in 11 patients. Arteriography was carried out in 5 patients and showed hypervascularization and arteriovenous anastomoses in the clubbed fingers. The gas analysis of the arterial blood did not show any pathological changes. The histological finding showed poorly vascularized and oedematous periarticular tissue and ossification in the periosteal area, while in the synovial membrane, slight, nonspecific inflammatory changes were seen.

[Early cancer of the stomach as a gastroenterological problem]. / Pocenti rak zeluca kao gastroenteroloski problem.

The article analyzed the problem of early gastric cancer; definition, endoscopic and surgical intraoperative diagnosis and kind of surgical treatment, and also results. It's emphasize importance of the diagnosis early gastric cancer. In that treated cases of early gastric cancer prognosis is excellent (85 -- 92%). The result of 6032 endoscopic examinations are: 360 cases of gastric cancer, and 14 was early gastric cancer. Surgical treated was eleven cases, and they are all have been lived. In the article is extensive discussion the problem of histopathological diagnosis and classification. Extensive is described operative proceed for which we think that is best in treated of early gastric cancer.