[Dilemmas in indications for emergency revision surgery of postoperative complications in abdominal surgery - contribution to the problem]. / Dileme u indikacijama za urgentnu operativnu reviziju postoperativnih komplikacija u abdominalnoj hirurgiji - prilog problematici.

The percentage of complications following an interval or emergency operative interventions in the abdomen is different and depends on several factors: -Proper indication for surgery -Experience of the surgical team, anesthesia -Extent of pathological changes; -patient's general condition (presence of associated diseases, capacity of the cardiovascular system, a.o.). -The immediate postoperative treatment. In more experienced surgical departments this percentage is about 5%, but it can rise higher. Postoperative complications representing an indications for emergency re-laparotomy (besides bleeding, also appearing on the first postoperative day, or immediately following the surgery), usually appear from fourth to the seventh day and their common cause being disruption of the anastomosis at different levels of the guts: from gaster to colon and recto-sigmoid. The authors their ten years experience in 40 patients operated upon because of malignomas of the gastro-intestinal tract, but also because of benign processes. A delay of re-operation can--from one part--have fatal consequences, threatening the patient's life; and from another part the re-operation as a complementary (added) aggression on the almost exhausted patients, can by itself kill such patients. In every case, the mortality rate rises over 50%. The authors detail and systematically present their patients and they point out the importance of making decision, which represents the basic dilemma.

[Possibilities of traffic-injury prevention using seat belts and their disadvantages]. / Mogucnost prevencije saobracajnih traumatizama sigurnosnim pojasom i njegove nezgode

As a result of the increasing number of serious injuries, and/or deaths caused by automobile accidents, seatbelts, along with other safety items are installed in cars. The idea of having automobile seatbelts came from the aircraft seatbelt. In our country there is no law requiring installation of seatbelts in all automobiles. Most imported cars, however do have built-in seat builts which are more or less used by the drivers and passengers. Wearing seatbelts is a necessity because, according to statistics, of 100,000 registered vehicles, 340.8 drivers and/or passengers lose their lives. In Sweden however, this value is 44.1 or eight times less. The number of injuries in Yugoslavia is also great. One of every three injuries are serious with chances of causing invalidity. The basic cause of death in an automobile accident is being thrown out of the vehicle by inertia during a collision has a five fold less a chance of surviving than if he were not thrown out. Secondary impacts of the passenger's body with objects within the automobile are: dashboard, doors, steering wheel, etc. are also a significant cause of many severe injuries. The force of inertia of a 70 kg passenger when the vehicle in which he is riding decelerates from a speed of 80 km/hr to 0 km/hr in a time span of 0.14 sec, and distances of 2 meters equals 878.83 kg. The greater the force of inertia is: (sometimes reaching 2000 kg). The advantages of the safety belt are in that they prevent ejection and secondary impacts of the passenger with protruding objects within the passenger compartment. Today the 2-point seatbelt is no longer in use, having been replaced by the 3-poing seat belt. The 3-point seatbelt must fit snugly about the wearers body so that it cannot be pulled away more than a distance of one or two fingerbreadths. The automatic 3-point seat belt, (the latest of designs), permits freedom of body movement. Should a collison occur, the seat belt locks in position holding the passenger back against the force of inertia. Disadvantages of the seat belt are illustrated by what is reffered to as the seat belt syndrome which was introduced by the American authors Garrett, and Baraunstein (1962). The presented 2,778 cases involved in automobile accidents, in which at least one passenger in each of the vehicles involved was wearing a seatbelt: 2,325 people). Of these 2,325, 944, 29%, or every third person was injured. 150 of them were injured on their lower torso. 26, or 0.8% were seriously injured. Not one case, however resulted in death. The seatbelt syndrome can be recognized by several characteristic injuries. In the event of a collision, those wearing seatbelts usually sustain multiple bruises and/or lacerations of the head, contusions of the lower abdomen with excoriation, adrasions, internal hemorraging, fractured ankle of foot. When such injuries are confirmed it is necessary to carefully search for injuries to internal organ as they usually accompany the above mentioned...