Patterns of injuries and motor-vehicle traffic accidents in Athens.

The extremely high cost of motor-vehicle accidents in public health leads to the necessity of a better injury data collection in the Accident and Emergency Hospital Departments. The 'Asclepeion' of Voula Hospital covers the southeastern suburban areas of the greater Athens area (1,000,000 population). The aim of this study is to present information on the pattern of injuries in Athens, in order to understand the magnitude of the problem and develop rational prevention programmes. Specially trained health visitors of the Emergency Department Injury Surveillance System (EDISS) interviewed in person every injured victim who was brought into the Emergency Service of the 'Asclepeion' of Voula Hospital. The study was performed during a 3-year period, from 1996 to 1998; 4564 persons were interviewed. Traffic accidents were more frequent on weekdays with a seasonal peak in July and among young Greeks (aged 25 - 34 years). The usual type of injuries seen in vehicle-accident victims were cerebral contusion and concussion, while in motorcycle-accident victims, head contusion and fractures. The most common reasons for the accident were excessive speed, poor condition of road, inattention, abstraction or drowsiness and drug effects. A total of 29.8% of motorcycle drivers and 5.7% of motorcycle passengers wore a helmet and 26.3% of car drivers and 14.1% of car passengers were using seatbelts. The identification of road traffic injury patterns can contribute to the development of injury prevention measures and guide rational preventive interventions that can reduce the incidence of these injuries. The EDISS system established at 'Asclepeion' of Voula Emergency Service can provide useful and accurate information about this serious and multidimensional problem of Greek Public Health.

Clinical presentations and surgical management of liver hydatidosis: our 20 year experience.

BACKGROUND: Hydatidosis/echinococcosis of the liver is a very old problem in Greece and still exists, although it is declining. We have reviewed our 20 years' experience, and here we report the various clinical presentations of the disease and evaluate the clinical outcome of the surgical procedures performed. PATIENTS AND METHODS: We conducted a retrospective analysis of the past 20 years' medical records; 35 patients (males 34%, females 66%, mean age 58 years) were treated surgically. Results. The presenting symptoms or findings leading to the diagnosis of liver echinococcosis were jaundice (six cases, 17%), abdominal pain (five cases, 14%), gastrointestinal discomfort of the upper abdomen (e.g. nausea, vomiting, distention, anorexia) (two cases, 6%), acute pancreatitis (one case, 3%) and portal hypertension (one case, 3%). The rest of the cases were diagnosed incidentally (20 cases, 57%). External drainage and cystectomy with omentoplasty was performed in 21 cases (60%) and pericystectomy in 14 cases (40%). The mean hospital stay was 16.8 days. Morbidity and mortality were 18% and 3%, respectively, with no statistically significant differences between the two surgical approaches. The recurrence rate averaged 3%. DISCUSSION: A high index of suspicion is recommended when variable clinical manifestations of the upper abdomen are present. Meeting all criteria for surgical treatment of hydatid disease, external drainage and cystectomy should be the standard surgical procedure. Pericystectomy could be used for peripherally located liver cysts that are only partially surrounded by parenchyma. Resection procedures are considered too radical for a benign disease. Appropriate randomized controlled studies are needed to establish the definite surgical management of liver hydatidosis, including modern techniques such as laparoscopy and transcutaneous puncture under US guidance (PAIR technique).

Aortic transsection after blunt chest trauma.

We report a case of an 18-year-old female who developed an extensive hemothorax after blunt chest trauma. Transesophageal echocardiography (TEE) showed transsection of the aorta at the level of the isthmus and turbulent flows in several places around the aorta. We discuss the contribution of TEE for detecting traumatic injuries to the thoracic aorta.

Blunt injuries of the stomach.

OBJECTIVE: To evaluate the results of surgical treatment of patients with blunt injuries of the stomach. DESIGN: Retrospective study. SETTING: Two general hospitals, Greece. SUBJECTS: 10 patients operated on for blunt trauma to the stomach during a 10 year period. MAIN OUTCOME MEASURES: Hospital mortality and morbidity. RESULTS: All patients were victims of motor vehicle accidents and presented with clinical signs warranting early laparotomy. There were 6 full-thickness, and 2 partial thickness gastric injuries located in the anterior wall. All injuries could be managed with simple surgical techniques without resections. Two patients bled to death on the operating table from associated injuries. All but one of the survivors had postoperative complications with a mean (SD) duration of hospital stay of 18(8) days (range 10-30). CONCLUSIONS: Blunt gastric injury is usually diagnosed at laparotomy for associated injuries but may occasionally be suspected from specific clinical findings. In most cases the injury is on the anterior wall. Simple repair is usually sufficient and the prognosis depends on the severity of the associated injuries.