[Scoring system for evaluation of clinical outcome of severe injuries in patients].

A trauma-scoring system converts the severity of injury into a number, so helping clinicians to define patient's condition. Aim of our investigation was assessment of scoring systems in clinical outcome of patients with severe traumatic injury, as well as ISS, AIS, APACHE II and SOFA score were counted. Mean age of traumatized patients was 35 yrs, predominantly males. Based on results of our investigation we concluded that ISS, APACHE II and SOFA score adequately can be used for predicting clinical outcome of severe traumatized patients.

[Liver injuries--personal experience with treatment].

BACKGROUND: Trauma is one of todays most serious and expensive health care problems, and it is the most common cause of mortality in young population. Non-operative tretment is standard strategi for menagment of blunt liver injuries in hemodynamically stable patiens in last decade. METHODS: Retrospective study included patiens with liver trauma, admitted in the period december 1995 - december 2005, in total 476. RESULTS: 392 of 476 patients presenting with liver trauma had blunt and only 84 had penetrating injury. Isolated liver injury was identified in 27.5% and 72.5% had associated injuries. Average ISS value was 24.06 (SD = 14.26).During the operation liver injury in patients was classified according to Moor. In 2% critical patients, due to hemodynamic unstability we performed "damage control surgery". Out of 476 patients 8.7% were successfully managet, 6.1% died as "mors in tabula" or during first 24 hours and 6.9% died during hospitalization. CONCLUSION: Higher proportion of nonoopertively treated is among patients with ISS less thanand those with injuries grade I end II.

[The influence of risk factors in recurrent peptic ulcer haemorrhage].

Gastrointestinal hemorrhage is one of the most frequent complications that occurs in 15 20% patients with peptic ulcer disease. Recurrent ulcer haemorrhage presents in the first 72 hours after initial bleeding: they are the most im portant cause of death. The aim of our study was to show the possibility of ulcer recurrent haemorrhage combined with risk factors: age 60, high risk lesion (active arterial bleeding, visible blood vessel, adherent coagulum), the size, ulcer base and localization (posterior duodenal wall. lesser curvature or high gastric ulcer), commorbidities ( cardiovascular and liver diseases) and haemodynamic instabilities. The combination of these risk-factor, unproportionally increases the risk: presence of two risk factors gives the possibility of recurrent bleeding of 16.67%, three risk factors 58.82%, four 93.33%, while the presence of five risk factors shows 100% posibility. Probability of death is 8.27 times greater if ulcer haemorrhage occurs.

[Surgical perspectives in treatment of bleeding peptic ulcers].

Peptic ulcer bleeding has overall incidence of 50 to 150 on 100.000 grown-ups per year and represents cause for over 1% of all urgent hospitalization today. Despite of the evolution of the endoscopic diagnostics and haemostasis, improved intensive care and surgical treatment, overall mortality is still over 10% (operative treatment over 20%), and it almost hasn't changed over past 40 years. For more than 100 years surgery had major role in treatment of peptic bleeding ulcers, whereas nowadays it is limited to treatment of its complications. Adequate surgical treatment demands properly timed operation, safest but appropriate operation and trained surgeon. Early surgery is much better compared to the last minute surgery. At high risk rebleeding ulcer, early delayed surgery appears to be adequate, since the complications and lethal outcome are more frequent in this group.