Injuries caused by antipersonnel mines in Croatian Army soldiers on the East Slavonia front during the 1991-1992 war in Croatia.

During the war in Croatia, antipersonnel mines were mostly laid without plan by both sides, with no minefield layout, especially on the East Slavonia front. A group of Croatian disabled war veterans wounded by antipersonnel mines at the East Slavonia front from June 1, 1991, to September 1, 1992, were analyzed. The front line between the Croatian Army units and Serbian paramilitary units mostly ran along a lowland, partially swampy and wooded ground, convenient for large-scale laying of antipersonnel mines, especially so-called surprise mines. Fifty-seven soldiers suffered injuries caused by antipersonnel mines, 27 (47.4%) of them by pressure-activated mines and 30 (52.6%) by pull-action mines. The severity of wounds was assessed according to the Abbreviated Injury Scale (AIS). In the group of patients with wounds inflicted by pressure-activated mines, the mean AIS score was 4.0 +/- 0.7, with injuries to the lower extremities (mostly feet) ranging from foot-mutilating defects to partial lower-leg amputation. In the group of patients with injuries caused by pull-action mines, the mean AIS score was 3.0 +/- 0.9, indicating relatively minor injuries of different types according to the mechanism of wounding and localization. A failure to comply with minelaying regulations made protection impossible and resulted in a relatively high proportion of the wounded. The same problems are now encountered on mine removal. According to estimates, at least 10 years of intensive work of 2,000 to 3,000 trained experts will be required to clear some 2 million mines laid all over the area.

Type, severity, location, and timing of battle casualties in a Croatian Army brigade during an offensive action in 1992.

AIM: To analyze the type, severity, location, and timing of casualties in a Croatian Army brigade during an offensive action against enemy forces of about two infantry battalions timely prepared for defense. METHODS: Casualties were analyzed according to bilateral manpower and equipment conditions, morale, time of the day, weather conditions, type of ground where the action took place, quality of planning and steering the course of the action, and especially the medical help. The action was carried out along one main and two auxiliary directions, including river crossing. The action involved about 1,000 soldiers and took 7 hours. It was divided into three phases: approaching the enemy, direct contact, and self-imposed retreat and evacuation. Medical care for the injured soldiers was organized in echelons, relying on civilian health care institutions. RESULTS: During the action, 92 casualties were recorded. The mean injury severity according to the Abbreviated Injury Scale (AIS) was 2.9+/-1.4. The highest proportion of casualties occurred on the main direction (48 or 52.2%) but the most severe injuries were inflicted on the second auxiliary direction (mean AIS, 2.6+/-1.4). Extremely severe injuries (mean AIS, 2.0+/-1. 4) were recorded on the second auxiliary direction during the phase of retreat after a successfully performed action. However, regarding the whole action, the observed differences did not prove to be statistically significant. CONCLUSIONS: Offensive action was properly planned and successfully led during the first two phases. Evacuation and retreat of the brigade were in part poorly organized. Health care for the soldiers functioned well throughout the action.

Injuries in Croatian Army brigade soldiers inflicted in an offensive action during the 1991/1992 war in Croatia.

The type and number of injuries sustained by soldiers of a Croatian Army brigade in an offensive action during the war in Croatia (1991/1992) were analyzed according to the mechanism of wounding. About 1,000 soldiers participated in a 6-hour offensive action in a flat, partially swampy, and wooded area, convenient for large-scale use of antipersonnel mines and other explosive devices. There were 92 casualties in total: 15 soldiers were killed in action and 77 were lightly or severely wounded. The mechanism of wounding included shell fragments in 44 soldiers (47.8%), antipersonnel mines and gunshot projectiles in 14 soldiers each (15.3%), and others (fall, blow, stress, etc.) in 20 soldiers (21.7%). Death was recorded in 1 of 13 soldiers (7.1%) with gunshot wounds, 11 of 44 soldiers (25%) wounded by shell projectiles, and 4 of 14 soldiers (28.5%) wounded by antipersonnel mines. All injuries inflicted by shell fragments were multiple, whereas the type and severity of injury inflicted by antipersonnel mines were directly related to the type of mine. Pressure-activated mines generally caused limited injuries to the lower extremities, ranging from mutilation to amputation. Injuries inflicted by other antipersonnel mines resembled those caused by shell projectiles; however, their severity depends on a number of factors.

Determination of coronary flow measurements by transesophageal echocardiography: dependence of flow velocity reserve on the location of stenosis.

Doppler velocimetry with the use of transesophageal echocardiography can record flow in the proximal left anterior descending artery (LAD). To assess whether this limited sampling ability influences the recording of velocity and the calculation of coronary flow reserve (CFR), 32 patients with LAD stenosis (4 ostial stenoses, 18 proximal stenoses, 10 mid-LAD stenoses) and 33 patients with arteriographically normal LADs were studied. Basal flow and dipyridamole-induced hyperemic flow rates were recorded. The mean basal flow velocity in ostial stenoses was greater than in other groups, and the mean basal flow velocity in proximal stenoses was less than that in mid-LAD stenoses and in the normal group. Maximal hyperemic velocity did not differ between the groups. CFR in all stenoses groups was less than that in the normal group. Ostial CFR was less than in all other groups, and proximal CFR was less than that in either the mid-LAD or the normal LAD groups. With this technique, coronary flow velocimetry and estimation of CFR is affected by the location of stenosis.

Method for assessing cardiac function using magnetic resonance imaging.

The authors sought to define a method to use magnetic resonance (MR) to assess cardiac function by obtaining short-axis images of the left ventricle (LV) in humans. Sagittal and axial scout1H MR images were used in the protocol. The long axis of the LV was defined in both planes using the mitral valve and left ventricular apex as references. Based on this double angulation, the acquisition planes were created for a series of parallel short-axis images extending from the base to the apex of the left ventricular cavity. Cardiac images acquired with a fast-field echo technique, six slices with 16-20 phases per RR interval, were analyzed, representing the initial 75-80% of the cardiac cycle. For each slice, the endocardial border of the left ventricular chamber was manually traced. Using Simpson's rule, the total LV volume at a given phase was determined, considering the traced area, thickness, and position in three-dimensional space of each of the six constituent slices. The calculated volumes were plotted against time, and the stroke volume, ejection fraction, and cardiac output were determined. These parameters are clinically significant indices of cardiac function. Accurate and useful estimates of LV function can be obtained using MRI according to this protocol.

Transesophageal assessment of coronary flow velocity reserve during "regular" and "high"-dose dipyridamole stress testing.

To assess the effect of regular and high-dose dipyridamole on coronary flow velocity in the left anterior descending artery (LAD), and to determine whether assessment of coronary flow velocity reserve (CFVR) is more sensitive for detection of ischemia than standard echocardiographic criteria, 47 patients were studied prospectively: 16 patients with stenosis of the LAD, 18 patients with angiographically normal LADs, and 13 patients with minimal disease. Patients underwent transesophageal echocardiographic study of wall motion and LAD flow velocity at baseline and at hyperemia, and for angina and electrocardiographic changes. The mean CFVR values after 0.56 mg/kg after 0.84 mg/kg of dipyridamole were similar: 2.52 +/- 0.87 versus 2.62 +/- 0.90. A CFVR <2.3 (normals mean -2 SDs) was more sensitive (88% at both doses) for the detection of underlying coronary obstruction than was wall motion monitoring (44% and 75%, respectively). The combination of CFVR <2.3 and wall monitoring was more sensitive than index alone (94% at both 0.56 and 0.84 mg/kg). The rate-pressure product was not significantly different at the two doses of dipyridamole. When flow response is the end point of stress testing, as with transesophageal monitoring, the 0.56 mg/kg dose of dipyrid mole is adequate, but when ischemia is the end point (as with wall motion monitoring by 2-dimensional echocardiography), the dose of 0.84 mg/kg is more sensitive.

Medical corps support to a brigade action during an offensive action including river crossing.

This paper describes medical support to a Croatian Army brigade of 2,100 soldiers in an attack combined with river crossing during the 1991/1992 war in Croatia. Three crossings across the river, 4,000 to 5,000 m apart, were used along a front of a total width of 14 km. The anticipated depth of the attack was about 4 km. It was estimated that the enemy had about 1,000 fortified soldiers supported by a corresponding number of artillery and other weapons. The medical corps were strengthened for this particular action by manpower and boats, and the soldiers by additional medical accessories (bandages and triangular slings). During the action, 78 Croatian Army soldiers were wounded, 7 were killed, and 8 were missing. The condition of the wounded soldiers did not worsen during transport. The mean duration of the transport was 90 minutes (maximum 2 hours). Twenty-six percent of the wounded were definitively treated by the brigade medical corps. One physician was included among the seriously wounded. The enemy had more than 150 dead and about 300 wounded. Upon achievement of the planned objectives, the action was interrupted by a high command decision and the brigade returned to its initial position.

MRI-derived ventricular volume curves for the assessment of left ventricular function.

To assess the utility of double oblique, ECG-gated 1H magnetic resonance (MR) derived volume curves for assessing LV function, cardiac short axis images were acquired with a fast field echo technique. We applied this methodology to assess left ventricular function in three groups: normals, patients with left ventricular hypertrophy, and dilated cardiomyopathy. Six slices with 16-20 phases per RR interval were analyzed, representing the initial 75-80% of the cardiac cycle. For each slice, the endocardial border of the left ventricular (LV) chamber was manually traced. Using Simpson's rule, the total LV volume at a given phase was determined considering the traced area, thickness and position in three-dimensional space of each of the six constituent slices. The calculated volumes were plotted against time and the stroke volume, ejection fraction and cardiac output were determined. The volume vs time plots for the systolic and diastolic portions of the curve were individually fit to third degree polynomials using a least squares approximation. From the fit curves, the following data were extracted: the mean slope (dV/dT) during filling and emptying, and the time to 1/4, 1/3 and 1/2 filling and emptying. These parameters are valuable indices of the functional status of the myocardium; thus, accurate and useful estimates of LV function can be obtained using MRI derived volume curves in normal and abnormal states.