Patterns of anatomical injury and anaesthesia procedures in wounded Ukrainian soldiers from Anti-Terrorist Operation/Operation Joint Forces: 2014-2021.

INTRODUCTION: The study aims to analyse the causes and anatomical patterns of explosive and gunshot wounds in Ukrainian soldiers acquired during the Anti-Terrorist Operation/Operation Joint Forces. We also investigated how general and regional anaesthesia procedures affected post-operative pain in wounded soldiers. METHODS: A retrospective observational study was done based on the medical records of Ukrainian soldiers wounded in the Anti-Terrorist Operation/Operation Joint Forces between 2014 and 2021. The collected data included the American Society of Anesthesiologists score, mechanism of injury, the pattern of anatomical injury, pain intensity and the choice of anaesthesia given. Pain intensity was diagnosed using a Numerical Rating Scale. RESULTS: A total of 280 combat casualties with explosive (75.7%) and gunshot (24.3%) wound injuries were included in the study. Most of the wounded soldiers had one body region affected by injury (59.3%). In most of the cases, the affected body regions were lower (48.2%) and upper (33.8%) limbs. In 62.5% of patients, regional anaesthesia was used, while general anaesthesia was used in 37.5% of cases. The pain significantly decreased after initial treatment at the field medical unit regardless of the anaesthesia type or the number of affected body regions. CONCLUSION: Understanding the sources and anatomical patterns of war-related injuries in recent conflicts is an important element in reducing the mortality and suffering of wounded soldiers. The high percentage of injured extremities in our cohort emphasises the importance of regional anaesthesia in contemporary wars.

The effects of intraganglionic injection of calcium/calmodulin-dependent protein kinase II inhibitors on pain-related behavior in diabetic neuropathy.

Calcium/calmodulin-dependent protein kinase II (CaMKII) has been implicated in the transmission of nociceptive input in diabetic neuropathy. The aim of this study was to test whether intraganglionic (i.g.) injection of CaMKII inhibitors may alleviate pain-related behavior in diabetic rats. Diabetes was induced in Sprague-Dawley rats using 55 mg/kg streptozotocin intraperitoneally. Two weeks after diabetes induction, CaMKII inhibitors myristoil-AIP and KN93 were injected directly into the right L5 dorsal root ganglion (DRG). Behavioral testing with mechanical and thermal stimuli was performed before induction of diabetes, the day preceding the injection, as well as 2 and 24h after the i.g. injection. The expression of total CaMKII and its alpha isoform in DRG neurons was analyzed using immunohistochemistry. CaMKII inhibitors attenuated pain-related behavior in a modality-specific fashion. Attenuation of nociceptive behavior was accompanied with a corresponding decrease of CaMKII alpha expression in DRG neurons on the side of injection. A significant decrease of CaMKII alpha expression was seen in small- and medium-sized neurons. In conclusion, our study provides evidence that CaMKII inhibitors are potential pharmacological agents that should be further explored for treatment of diabetic neuropathy symptoms.

Attenuation of pain-related behaviour evoked by carrageenan injection through blockade of neuropeptide Y Y1 and Y2 receptors.

BACKGROUND: It is well known that neuropeptide Y (NPY) participates in the modulation of chronic pain, but its exact role has not yet been fully explained. In this study, we explored whether targeted delivery of NPY and its antagonists into dorsal root ganglion (DRG) modulates pain-related behaviour in rats with experimentally induced inflammatory nociception. METHODS: Inflammatory nociception was induced by intraplantar carrageenan injection. Immediately after carrageenan injection, NPY or its antagonists were injected directly into DRG. Behavioural testing was performed on the day preceding the carrageenan injection and four times (5 h after, on the first, fifth and eighth days) following the injection. Immunohistochemical analysis was performed 8 days following the surgery. RESULTS: Our results showed that NPY, applied directly to DRG, induced cold allodynia in carrageenan inflammatory pain model. NPY in carrageenan-injected rats did not additionally exacerbate activation of satellite cells in DRG and astrocytes in dorsal horn caused by intraplantar carrageenan injection. However, application of NPY Y1 and Y2 antagonists directly into DRG reversed carrageenan proalgesic effects and reduced gliosis in DRG and dorsal horn. CONCLUSION: These findings indicate an important link between pain-related behaviour and neuroimmune actions of NPY Y1 and Y2 receptors.

Morphological characteristics of dying cells in axial structures of developing human embryos.

Programmed cell death (PCD) is a widespread phenomenon in the development of vertebrates. In most cases, dying cells during development exhibit generalized morphological features typical of apoptosis. We analyzed the morphological features of dying cells in the developing axial structures of 5 human embryos between 5 and 8 weeks of postovulatory age. Cell death in the axial structures, i.e. spinal cord, notochord and surrounding mesenchyme and somites, was analyzed using light and electron microscopy. Tissue samples were taken from the cervicothoracic region of normal human conceptuses. Two morphological types of cell death were found: apoptosis which was characterized by round or semilunar nuclear chromatin condensations, condensation and shrinkage of the cytoplasm and formation of apoptotic bodies, and cell death without the morphological features of apoptosis which was characterized by pyknotic nuclear chromatin condensations, vacuolated cytoplasm and the formation of numerous intercellular spaces. Apoptotic death occurred during the 5th week of normal development in all the axial structures. Later, apoptotic death appeared in all the axial structures, with the exception of the notochord, where some dying cells displayed features of secondary necrosis. According to our findings, apoptosis seems to be the most frequently observed type of PCD, but it is not the exclusive type of morphological cell death during the development of axial structures in human embryos.

Staging in untreated patients with small cell lung cancer.

In order to describe the real biological behavior of the small-cell lung cancer we have analyzed survival rates of 66 patients with small-cell lung cancer who did not receive any specific anti cancer therapy. Also, objective of this study was to evaluate the staging system of the small-cell lung cancer. Untreated small-cell lung cancer patients with limited stage disease had statistically significant (p < 0.05) better survival rates in comparison to patients with extensive stage disease. T and N factor of the TNM classification did not influence the survival in untreated small-cell lung cancer patients. It appears that the TNM staging system is not predicting survival probabilities of untreated patients with small-cell lung cancer, while the two-stage system appeared very well based on survival probabilities of these patients.

Morphological diversity of dying cells during regression of the human tail.

During normal human development a number of transient structures form and subsequently regress completely. One of the most prominent structures that regress during development is the human tail. We report here a histological and ultrastructural study of cell death in the cranial and caudal (tail) parts of the neural tube in 4 to 6-week-old human embryos. Initially, the human tail is composed of tail bud mesenchyme which differentiates into caudal somites, secondary neural tube, notochord and tail gut. Later on, these structures gradually regress by cell death. During the investigated period, we observed two morphologically distinct types of dying cells. The well-described apoptotic type of cell death was observed only in the cranial neural tube that forms during primary neurulation. The other type of cell death characterized by necrotic morphology was observed in the tail mesenchyme and in the caudal neural tube that forms during secondary neurulation. This morphological diversity suggests that besides differences in origin and fate there are different mechanisms of developmental cell death between two parts of the human neural tube. We can speculate that the apoptotic type of cell death is associated with the precise control of cell numbers and that the other morphologically distinct type of cell death is responsible for the massive removal of transitory structures.

[The Medical School of Split--overview of its activity from independence until today]. / Medicinski fakultet u Splitu. Pregled aktivnosti od osamostaljenja do danas.

The aim of this report is to describe the current status of medical education program in the University of Split Medical School and to investigate readiness to accept modern trends in medical education. The report comprises the four-year period, since establishment of independent medical school up to day. The crucial elements of the high education reform with special emphasis on medical education are included in the report. The development of the faculty is still burdened with lack of personnel, poor market orientation and relatively small scientific production. The financial report, scientific production data, and information about student performance are also included. The decision that all exams must be passed before enrolment to the next academic year showed full justification. Although exposed to strong criticism, our new curriculum implemented four year ago is still unchanged. Joint effort of all medical schools in Croatia has to be directed to the follow up of all information important for the medical education, development of the quality assurance mechanisms and to enhancing state examination, standard for the evaluation of the medical schools' quality.

[The curriculum plan for the Split University Medical School--a modern concept for a new school]. / Nastavni plan Medicinskog fakulteta Sveucilista u Splitu--suvremena koncepcija za novi fakultet.

The transformation of the Zagreb University Medical School into an independent medical school, i.e., Split University Medical School prompted us to develop a new curriculum which had to adapt Zagreb curriculum to the new circumstances and to overcome its weaknesses. Additional reasons for new curriculum were the need for implementation of the current trends in medical education and adaptation to the Split Faculty. Principles according which the curriculum was developed took into account the current international recommendations on medical education, equal treatment of all teaching subjects, flexible curriculum and vertical integration of the elective subjects. New curriculum requires substantial changes in the organization of the undergraduate teaching. Because of the differences between Croatian medical schools, it is impossible and unnecessary to have a unique curriculum. Joint effort of medical schools has to be directed to the development of a common curriculum core and corresponding computer base of questions for examinations, enhancing state examination development, standard for the evaluation of the medical schools' quality.

Computing for the next millennium.

Computer technology has changed our lives, even that of physicians. In a few years time, a physician can expect to have a new tool by the bedside: a hand-held computer small enough to put into a pocket and powerful enough for all everyday activities, including highly specialized and sophisticated activities such as prevention of adverse drug reactions. The Croatian Academic and Research Network (CARNet) was crucial in bringing the benefits of the information technology to the Croatian scientists. At the Split University School of Medicine, we started the Virtual Medical School project, which now also includes the Mostar University School of Medicine in neighboring Bosnia and Herzegovina. Virtual Medical School aims to promote free dissemination of medical knowledge by creating medical education network as a gateway to the Internet for health care professionals.

Surgical treatment of kinked internal carotid artery.

BACKGROUND AND AIMS: The aim of this study was to provide information on the diagnosis and treatment of kinking -- bends in the extracranial internal carotid artery (KICA), a rate but major and treatable cause of cerebral ischemia. PROJECT: A retrospective review of the seven-year experience in Split Hospital. ESSENTIAL DATA: The role of the surgical correction of carotid artery kinking has not yet been precisely defined. MATERIALS AND METHODS: Of the 86 carotid revascularization operations performed in 76 patients from 1988 to 1994, 21 (29%) patients underwent surgery owing to symptomatic kinking of the internal carotid artery. This group included 8 females and 13 males with a mean age of 57.3+/-5.5 years (range 44-70). Symptoms included cerebrovascular insults in 43%, hemispheric transient ischemic attacks in 33%, reversible ischemic neurological deficit in 24% of patients. The diagnosis was made using two-dimensional ultrasound scan and Doppler, computerised tomography and angiographic evaluation. Two methods were used: the elimination of kinking and graft of the internal artery onto the common carotid artery with excision of the kinked section of the artery and end-to-end anastomosis. Dense fibrous tissues around the kinked artery were removed and the artery was freed along its entire course. The anomalous relationship between the internal carotid artery, occipital artery and hypoglossal nerve was corrected. RESULTS: After surgery seventeen patients fully recovered without neurological complications. One patient died, one patient suffered permanent neurological deficit, two suffered from transient ischemic attacks. CONCLUSIONS: Anatomic reconstruction together with the correction and elimination of the affected segments of the carotid artery may prevent progressive cerebrovascular symptoms and is associated with a low morbidity and mortality rate.

Fibronectin expression in the developing human spinal cord, nerves, and ganglia.

AIM: Analysis of developmental role of fibronectin during differentiation of the human spinal cord, nerves, and ganglia. METHODS: Seven normal human embryos and fetuses between the 7th and 9th developmental week and a 9-week fetus with cervical spina bifida were histologically examined on hematoxylin and eosin stained serial paraffin sections of thoracic axial segments. Monoclonal antibody to the human cell fibronectin fragment was used for immunohistochemical detection of fibronectin. RESULTS: In the 7th and 8th week of development, fibronectin was weakly expressed in the ventricular and intermediate zones of the spinal cord. Intense fibrillar expression was found in the marginal zone of the spinal cord - first over the ventral gray horns and later over the lateral and dorsal gray horns, and along the pathways of ventral and dorsal roots of the spinal nerves and in the spinal ganglia. At 9th week, fibronectin expression disappeared in the ventricular and intermediate zones a nd became weak and granular in the marginal zone of the spinal cord. In the spinal cord of a 9-week malformed fetus with cervical spina bifida, fibronectin expression was completely absent. Fibronectin was expressed in the nerves and ganglia throughout the investigated period, both in normal and malformed human conceptuses. CONCLUSION: Transient expression of fibronectin in the human spinal cord coincided with the most intense neuronal differentiation. Temporal and spatial expression of fibronectin during normal development, and its absence in a malformed human fetus suggests developmental role of fibronectin for the normal formation of the spinal cord.

Clinical and radiological management of wartime eye and orbit injuries.

OBJECTIVE: The purpose of this study is to present our experience in treating 191 patients with eye and orbit injuries that occurred during the war in Croatia and Bosnia and Herzegovina. METHODS: The authors retrospectively reviewed the clinical and radiological management of wartime eye and orbit injuries in patients hospitalized at Clinical Hospital Split. RESULTS: Seventy-nine percent of the war eye and orbit injuries were caused by fragments of explosive devices, 9.9% by high-velocity missiles, and 8.4% by other objects. Most of the patients were admitted to the hospital within 24 hours of injury. The total number of injured globes was 222; 48.2% of globes had intrabulbar (mostly magnetic) foreign bodies, and 13% had extrabulbar intraorbital foreign bodies. Extensive wounds (perforation, double perforation, rupture, and evisceration/ enucleation) were encountered in 74% of patients, and 26% of patients had slight trauma. There was a statistically significant correlation between admission within the first 12 hours and postoperative visual acuity (Chi 2 = 3.93; p = 0.0474). CONCLUSION: Along with clinical examination, computed tomography is the most important diagnostic procedure in preoperative evaluation of various forms of globe and orbit injuries. The admission time is the most important factor in determining postoperative visual acuity.

Envenomation by the horned viper (Vipera ammodytes L.).

Snake venom poisoning is a medical emergency that requires urgent therapeutic procedures. The treatment of venomous snakebites is still controversial because of unclear therapeutic modalities. Choice of treatment is dictated in part by regional characteristics with regard to patient population and types of venomous snakes. The purpose of the study presented here was to report regional experience with venomous snakebites and to describe first-aid, pre-hospital, and hospital therapeutic procedures for horned viper bite. During a 16-year period, from 1980 to 1996, at the Clinical Hospital Split (Croatia) we collected data on 389 victims of horned viper bite. Incidence of the local and general complications is presented. We also reviewed therapeutic modalities and outcome with special attention to compartment syndromes and the indications for fasciotomy.

Medical support to a nonprofessional brigade during the Croatian Operation Storm.

A review and description is presented of medical support in the nonprofessional Croatian Home Guard brigade (2,200 soldiers) during the Croatian Operation Storm. Medical support was organized according to a straightforward and easily changeable model that enabled quick adaptations from defense to attack positions. It was provided initially on the front line by company reception units. Further support included battalion aid stations, brigade clearing stations, and the clinical Hospital (fourth echelon) in the nearby city. The brigade medical corps was all volunteers; 9 medical doctors (two women) and 20 medical technicians and nurses. Medical corps assets included a mobile surgical team, eight ambulance vehicles, two spare vehicles, and one helicopter. After one 3-day action, brigade losses were 3 dead, 31 wounded (14 with firearms), and 2 diseased. According to the available data, enemy losses were 25 dead, 4 wounded, 2 sick soldiers, and 48 captured. Transportation time from the battlefield to the hospital was between 60 and 75 minutes. There were no deceased (including enemy soldiers) because of insufficient medical support and/or transportation problems. The applied model of medical corps organization, elaborate preparations, good training, and excellent motivation had a major role in successful treatment of war casualties.

War injuries of the femoral artery and vein: a report on 67 cases.

During the war in Croatia (from May 1991 to December 1995), 67 patients with war injuries of the femoral vein and/or artery were treated at the Surgical Clinic of Split Clinical Hospital. All the wounded were admitted directly from the battlefield or from front-line hospitals. There were five women and 62 men with a median age of 29 (range 15-54) years. There were 70 arterial (28 isolated) and 49 venous injuries (six isolated). Forty-six arterial injuries were repaired by reverse vein graft. Four proximal profound femoral arteries were reconstructed. Major venous injuries were repaired, 11 by compilation autogenous vein graft. No synthetic grafts were used. Repair of veins with large defects using compilation saphenous vein grafts gave good results. Six profound femoral veins and two superficial femoral veins were ligated. Vein ligation should be avoided unless another life-threatening injury demands priority. Twenty-one patients required open prophylactic fasciotomy. Two patients died (3%) and three ultimately underwent amputation (5%). Intermittent hyperbaric oxygen therapy was given to 18 heavily wounded patients with beneficial effect. The results support an immediate and coordinated approach to femoral vascular trauma with repair of arterial and venous injuries.

[The Internet in medicine]. / Internet u medicini.

Internet is a global computer network that connects numerous smaller computer networks. During the last several years Internet has become enormously popular and the number of users in the world has increased to 30 million. Internet is now a major tool for sharing computers resources and for communication between individuals and scientific institutions. Internet also contains enormous quantities of medical information and knowledge. During the last several years, many new sites have emerged on the Internet, offering exciting and useful information on medical practice, research, decision support, and education. This article describes the history of the Internet, the various ways of connecting to it and some of the tolls particularly useful for medical doctors. This article provides a tutorial how to access the important medical resources that Internet offers to the clinicians, teachers, and researcher. Also this article will provide description of access, structure and contents of the two World Wide Web locations. BioMedNet is a location designed for biomedical research. It was chosen because of its exceptional quality and importance for researchers. The second described location is CHORUS, developed for continuing education in radiology.

[Reasons for founding a University of Split Medical School]. / Obrazlozenje potrebe osnivanja Medicinskog fakulteta Sveucilista u Splitu.

This article advocates a transformation of the Zagreb University School of Medicine Split Branch into an independent medical school, i.e. Split University School of Medicine. The difficulties stemming from the present organizational scheme of work of Medical School in Zagreb and its Split Branch, and particularly from the complex political and geographical relations, are a heavy burden thwarting the work of both institutions. On the other hand, the medicine in Split has all indicators which should guarantee a successful work of an independent medical school in the city. These indicators concern capacities of the local premises, number and quality of the faculty, long tradition of medical education, and recent educational, medical and scientific results. A particularly important argument is an immense need of southern Croatia and the neighbouring parts of Bosnia and Herzegovina for medical education. A careful analysis showed that the independent Medical School would neither impose additional expenses from the part of the Republic, nor cause an overproduction of physicians. A state examination organized so that the results of the candidates could be quantified, would provide an unequivocal answer to the question on the number of medical schools needed in Croatia and, more important, the picture of the quality of their work.

Effect of maternal hyperoxygenation on experimentally produced uteroplacental insufficiency in the rat.

The paper examines the effects of maternal hyperoxygenation on uteroplacental insufficiency produced by ligation of the uterine artery. Maternal hyperoxygenation did not significantly affect experimentally produced growth retardation or survival of the fetuses from the ligated horn. Analysis of the vascular anatomy revealed that additional oxygen improves the survival of fetuses compromised by uteroplacental insufficiency only in the presence of anastomosis between the uterine and ovarian arteries. The study demonstrated the importance of that anastomosis in evaluating the results obtained by this experimental model.

Differences in origin and fate between the cranial and caudal spinal cord during normal and disturbed human development.

Differences in histological appearance between the cranial and caudal parts of the spinal cord and associated axial organs were analyzed in 9- and 15-week-old human dysraphic fetuses and compared with normal fetuses. In human development the cranial part of the neural tube down to the lumbosacral level forms during primary neurulation, while its caudal part results from secondary neurulation. In the 9-week fetus with cervical spina bifida, the cranial spinal cord displayed a variety of morphological changes along the cranio-caudal axis. Spinal cord in the upper cervical region transformed into the area cerebrovasculosa, while the lower cervical and thoracic levels showed only disturbed differentiation of the cell layers and roof plate. The degree of the cranial spinal cord dysmorphogenesis correlated with anomalies of the underlying notochord and vertebral column. The caudal to lumbosacral region of the spinal cord appeared normal. In the case of the 15-week-old fetus with complete dysraphia, the area cerebrovasculosa was found along the whole extent of the cranial spinal cord, while more caudally, all axial organs showed a normal histological structure. Our findings confirmed a different origin for the cranial and caudal parts of the human spinal cord. The appearance of dysraphic disorders corresponded to the time of primary neurulation; therefore, they resulted in the faulty formation of the cranial spinal cord. Normally formed caudal spinal cord appears during secondary neurulation at later developmental stages.