[Helicopter transport of patients from Croatian Adriatic Islands and coastal area in the period from 1996 to 2002]. / Helikopterski prijevoz bolesnika s hrvatskih jadranskih otoka i priobalja u razdoblju od 1996. do 2002. godine.

For most of the Croatian Adriatic islands and coastal area, helicopter is the fastest, and for some remote areas the only effective way of patient transport. In Croatia, most of the aeromedical transports are performed by helicopters of 95th Air Force Base. During the post-war period, the number of civilian patients transported with those helicopters increased from 56 in 1996 to 311 in 2002, this trend continuing in 2003. The majority of these transports were performed in the third trimester of the year, the largest number of patients were transported from the Island of Hvar, and the most common medical indication for aeromedical trasport was trauma. The lack of competent medical escort may have unfavourable impact on patient health and flight safety. The increasing trend in requesting aeromedical transport would obviously justify the foundation of a specialized commercial service to provide both safe transport and competent medical escort.

Esophagotracheal fistula after lithium disc battery ingestion successfully treated with hyperbaric oxygen therapy.

We report a case of a 12-month-old child who acquired an esophagotracheal fistula of 5 mm in diameter after an ingested lithium disc battery impaction. Failure to recognize foreign body on chest X-rays resulted in a delay of 28 days in establishing the diagnosis. Feeding via nasogastric tube and hyperbaric oxygen treatment (HBOT) resulted in a complete closure of the fistula after 17 HBOT 60 min sessions at 2.2 bars.

Scuba diver with a knife in his chest: homicide or suicide?

A scuba diver was found dead at the bottom of an undersea cave at 54.1 m water depth, with a knife protruding from his chest. Autopsy confirmed death due to both drowning and a penetrating knife wound. The incident was first considered a homicide and two suspects were arrested. Careful forensic analysis of the profile of the diver's last dive stored in the dive computer, dimensions of the undersea cave, as well as other forensic findings, showed that the case was a suicide, which the diver most probably committed while running out of air, in an attempt to avoid the agony of drowning. To the best of our knowledge, this is the first report on a suicide during diving.

Differential diagnostic problems of decompression sickness--examples from specialist physicians' practices in diving medicine.

It can be expected that the differential diagnosis problem of decompression sickness will increase in the future due to the increasing number of divers. During the last 30 years, 232 divers were treated for decompression sickness (DCS) at the Naval Medical Institute (NMI) in Split, Croatia. In 66 cases (28%), physicians at various diving sites reached diagnosis with difficulty, and 86 divers (37%) came directly to the NMI without seeing a physician first. Physicians at remote diving locations frequently have only basic knowledge of diving medicine and are often inexperienced. The language barrier was a major obstacle in obtaining a medical history and examination of foreign divers. Consultations at the NMI proved a major contribution to correct diagnosis and treatment. We present six illustrative cases from NMI Archives that demonstrate how prejudices, panic, and inexperience could create problems in establishing DCS diagnosis.

Change of occurance of type 1 and type 2 decompression sickness of divers treated at the Croatian Naval Medical Institute in the period from 1967 to 2000.

A significant change of occurrence (p=0.0343) of type 1 and type 2 decompression sickness (DCS) of divers in Croatia was observed in the period from 1991 to 2002 (type 1: n=26, 37.68% and type 2: n=43, 62.32%) compared with the period from 1967 to 1990 (type 1: n=93, 52.84% and type 2: n=83, 47.16%). The change was attributed to the extensive usage of diving computers and artificial gas mixtures which enable extended bottom times and deeper dives, thus putting divers at an increased decompression risk. The importance of the results of this report is in the fact that permanent neurological deficit occurs only after type 2 DCS. Injured divers with permanent loss after type 2 DCS are not fit for diving and require a long term medical care, thus becoming a significant public health problem.

[Gas gangrene and hyperbaric oxygenation--a lesson forgotten or never learned?]. / Plinska gangrena i hiperbaricna oksigenacija--zaboravljena ili nikad naucena lekcija?

Gas gangrene develops in devitalized hypoxic tissue. It spreads rapidly under strong influence of enzymes produced by the causing bacteria and often results in fatal outcome. It is of utmost importance to stop toxin production as soon as possible, which is most effectively achieved by early application of hyperbaric oxygenation (HBO2), as the first measure in a "trident" (HBO2, antibiotics, surgical measures). The paper reviews the most important data from microbiology, pathophysiology and epidemiology of gas gangrene, current clinical practice, scientific basis for application of HBO2 in the treatment of this disease, and data from the archives of the Naval Medical Institute of the Croatian Navy in Split (NMI). At the NMI, in the period from 1982 to 2000, HBO2 was administered in the treatment of 21 patients with gas gangrene, of average age 41.6 +/- 16.3 years. The average treatment consisted of 6.8 +/- 3.8 sessions. 13 (76%) patients were cured.