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Buerger's disease (BD) remains a debilitating condition and early diagnosis is paramount for its effective management. Despite many published diagnostic criteria for BD, selective criteria have been utilized in different vascular centers to manage patients with BD worldwide. A recent international Delphi Consensus Study on the diagnostic criteria of BD showed that none of these published diagnostic criteria have been universally accepted as a gold standard. Apart from the presence of smoking, these published diagnostic criteria have distinct differences between them, rendering the direct comparison of patient outcomes difficult. Hence, the expert committees from the Working Group of the VAS-European Independent Foundation in Angiology/Vascular Medicine critically reviewed the findings from the Delphi study and provided practical recommendations on the diagnostic criteria for BD, facilitating its universal use. We recommend that the 'definitive' diagnosis of BD must require the presence of three features (history of smoking, typical angiographic features and typical histopathological features) and the use of a combination of major and minor criteria for the 'suspected' diagnosis of BD. The major criterion is the history of active tobacco smoking. The five minor criteria are disease onset at age less than 45 years, ischemic involvement of the lower limbs, ischemic involvement of one or both of the upper limbs, thrombophlebitis migrans and red-blue shade of purple discoloration on edematous toes or fingers. We recommend that a 'suspected' diagnosis of BD is confirmed in the presence of a major criterion plus four or more minor criteria. In the absence of the major criterion or in cases of fewer than four minor criteria, imaging and laboratory data could facilitate the diagnosis. Validation studies on the use of these major and minor criteria are underway.

There is wide regional variation in clinical practice and access to treatment for patients with diabetic foot ulcer (DFU) from countries in Central and Eastern Europe (CEE). A treatment algorithm that reflects current treatment practices while providing a common framework may facilitate best practice in DFU management and improve outcomes across the CEE region. Following a series of regional advisory board meetings with experts from Poland, the Czech Republic, Hungary and Croatia, we present consensus recommendations for the management of DFU and outline the key features of a unified algorithm for dissemination and use as a quick tool in clinical practice in CEE. The algorithm should be accessible to specialists as well as non-specialist clinicians and should incorporate: patient screening; checkpoints for assessment and referral; triggers of treatment change; and strategies for infection control, wound bed preparation and offloading. Among adjunctive treatments in DFU, there is a clear role for topical oxygen therapy, which can be used concomitantly with most existing treatment regimens in hard-to-heal wounds following standard of care. Countries from CEE face a number of challenges in the management of DFU. It is hoped that such an algorithm will help standardise the approach to DFU management and overcome some of these challenges. Ultimately, a regionwide treatment algorithm in CEE has the potential to improve clinical outcomes and save limbs.

Background: Buerger's disease (BD) remains a debilitating condition. Despite multiple published diagnostic criteria for BD, none is universally accepted as a gold standard., Methods: We conducted a 2-round modified Delphi consensus study to establish a consensus on the diagnostic. The questionnaire included statements from several commonly used diagnostic criteria for BD. Qualitative and quantitative analysis methods were performed. An agreement level of 70% was applied., Results: Twenty nine experts from 18 countries participated in this study. Overall, 75 statements were circulated in Round 1. Of these, 28% of statements were accepted. Following comments, 21 statements were recirculated in Round 2 and 90% were accepted. Although more than 90% of the experts did not agree that the diagnosis of BD can be based only on clinical manifestation, none of the nonclinical manifestations of BD were agreed as a part of the diagnostic criteria. There was an agreement that a history of tobacco consumption in any form, not necessarily confined to the current use, should be a part of the diagnostic criteria of BD. The history of thrombophlebitis migrans, even if not present at presentation, was accepted as a clue for BD diagnosis. It was also agreed that discoloration of the toes or fingers could be included in the diagnostic criteria of BD. Experts agreed that histology results could differentiate BD from atherosclerosis obliterans and other types of vasculitis. The presence of corkscrew collaterals on imaging and burning pain reached the agreement at the first round but not at the second. There was no consensus regarding age cut-off, the requirement of normal lipid profile, and normal blood glucose for BD diagnosis., Conclusions: The present study demonstrated discrepancies in the various published diagnostic criteria for BD and their selective utilization in routine clinical practice worldwide. We propose that all published diagnostic criteria for BD be re-evaluated for harmonization and universal use., (Copyright © 2022. Published by Elsevier Inc.)

Background: The corona virus disease (COVID-19) pandemic has radically changed the possibilities for vascular surgeons and trainees to exchange knowledge and experience. The aim of the present survey is to inventorize the e-learning needs of vascular surgeons and trainees as well as the strengths and weaknesses of vascular e-Learning., Methods: An online survey consisting of 18 questions was created in English, with a separate bilingual English-Mandarin version. The survey was dispersed to vascular surgeons and trainees worldwide through social media and via direct messaging from June 15, 2020 to October 15, 2020., Results: Eight hundred and fifty-six records from 84 different countries could be included. Most participants attended several online activities (>4: n = 461, 54%; 2-4: n = 300, 35%; 1: n = 95, 11%) and evaluated online activities as positive or very positive (84.7%). In deciding upon participation, the topic of the activity was most important (n = 440, 51.4%), followed by the reputation of the presenter or the panel (n = 178, 20.8%), but not necessarily receiving accreditation or certification (n = 52, 6.1%). The survey identified several shortcomings in vascular e-Learning during the pandemic: limited possibility to attend due to lack of time and increased workload (n = 432, 50.5%), no protected/allocated time (n = 488, 57%) and no accreditation or certification, while technical shortcomings were only a minor problem (n = 25, 2.9%)., Conclusions: During the COVID-19 pandemic vascular e-Learning has been used frequently and was appreciated by vascular professionals from around the globe. The survey identified strengths and weaknesses in current e-Learning that can be used to further improve online learning in vascular surgery., (Copyright © 2021. Published by Elsevier Inc.)

Even today thromboangiitis obliterans has disease features that remain misunderstood or underappreciated. The epidemiology, etiology and pathophysiology of the disease are still unclear. Biomarkers and disease activity markers are lacking, thus clinical assessment is difficult. We are still struggling to establish unique diagnostic, staging and treatment criteria. This is an academic-collaborative effort to describe the pathophysiology, the clinical manifestations, the diagnostic approach, and the challenges of management of patients with TAO. A systematic search for relevant studies dating from 1900 to the end of 2020 was performed on the PubMed, SCOPUS, and Science Direct databases. Given the intriguing nature of presentation of TAO, its management, to some extent is not only different in different regions of the world but also varies within the same region. Following this project, we discovered ambiguity, overlap and lack of clear-cut criteria for management of TAO. An international group of experts however came to one conclusion. They all agree that management of TAO needs a call for action for a renewed global look with multi-center studies, to update the geographical distribution of the disease and to establish a unique set of diagnostic criteria and a consensus-based guideline for best treatment based on current evidence.

This dataset supports the findings of the vascular e-Learning during the COVID-19 pandemic survey (the EL-COVID survey). The General Data Protection Regulation (GDPR) of the European Union was taken into consideration in all steps of data handling. The survey was approved by the institutional ethics committee of the Primary Investigator and an online English survey consisting of 18 questions was developed ad-hoc. A bilingual English-Mandarin version of the questionnaire was developed according to the instructions of the Chinese Medical Association in order to be used in mainland People's Republic of China. Differences between the two questionnaires were minor and did affect the process of data collection. Both questionnaires were hosted online. The EL-COVID survey was advertised through major social media. All national and regional contributors contacted their respective colleagues through direct messaging on social media or by email. Eight national societies or groups supported the dissemination of the EL-COVID survey. The data provided demographics information of the EL-COVID participants and an insight on the level of difficulty in accessing or citing previously attended online activities and whether participants were keen on citing these activities in their Curricula Vitae. A categorization of additional comments made by the participants are also based on the data. The survey responses were filtered, anonymized and submitted to descriptive analysis of percentage., Competing Interests: Nikolaos Patelis and Sean Matheiken are co-founders of the Med-PIE group (med-pie.com) Otherwise, the authors declare that they have no known competing financial interests or personal relationships which have, or could be perceived to have, influenced the work reported in this article. No funding was received., (© 2021 Published by Elsevier Inc.)

Introduction : We report a rare case of a symptomatic abdominal aneurysm presented as a lower limb deep vein thrombosis (DVT). Case presentation : A 63-year old male presented to our hospital with a recent progressive onset of the right lower limb swelling and pain. The patient had a history of a previous cardiovascular disease. A Duplex ultrasound was performed, which confirmed a right lower limb DVT extending to the right iliac vein. The patient had a pulsatile abdominal mass. Computed tomography scan of the abdomen showed an abdominal aortic and a right iliac artery aneurysm compressing the thrombosed inferior caval and the right iliac vein. The patient was treated with low molecular weight heparin. After resolution of the DVT on day 3 of hospitalization, a surgery on the abdominal and iliac artery aneurysm was performed. The aneurysm was resected and an aortobifemoral bypass was placed using a Dacron prosthesis. The patient remained to be asymptomatic for 6 months after the surgery. Follow up computed tomography demonstrated a fully patent inferior caval and iliac vein and the absence of the aneurysmal disease. Conclusion : Although rare, our case confirms that the DVT should be considered as a possible symptom of an abdominal aneurysm in selected patients.

Carotid endarterectomy is a common way of surgical treatment of extracranial carotid artery disease caused by atherosclerosis. Patients are often operated on under local anesthesia with intraoperative application of heparin. Postoperative bleeding occurs in up to 8% of cases, and up to 4.7% of patients need reoperation due to bleeding. TachoSil is a medical sponge consisting of collagen with added human coagulation factors (fibrinogen and thrombin). In contact with water, blood or bodily fluids, it forms a clot that adheres to the surface. The hypothesis and aim of our study was to show that TachoSil could be topically administered during surgery on carotid arteries in order to prevent minor bleeding, without causing any local signs of inflammation or infection. The study included a prospective series of consecutive patients that underwent surgery for extracranial carotid stenosis with concomitant antiplatelet therapy at Department of Vascular Surgery, Merkur University Hospital in Zagreb. All patients received antiplatelet therapy with aspirin or aspirin and clopidogrel until the day before surgery. From April 2, 2012 to February 8, 2013, a total of 24 patients with extracranial carotid artery stenosis were operated on, along with receiving antiplatelet therapy. All patients received 100 mg of acetylsalicylic acid and/or 75 mg of clopidogrel until one day prior to surgery. Patients had been treated with antiplatelet drugs for at least six months prior to carotid endarterectomy. Four patients had been on dual antiplatelet therapy (aspirin 100 mg and clopidogrel 75 mg) because of percutaneous transluminal angioplasty (PTA) and a stent placed in pelvic arteries or superficial femoral artery. Due to speech disturbances following clamping of carotid arteries in two study patients a temporary intraluminal shunt was created. These two patients underwent longitudinal arteriotomy and longitudinal endarterectomy. Arteriotomy was closed by direct suture without a patch. Following arteriotomy and partial conversion of heparin with protamine, six patients needed additional individual sutures. Then, protamine was added again to up to the full dose of conversion (50 mg). In 19 patients, only one TachoSil medical sponge (9.5 cm x 4.8 cm) was placed, whereas in fi ve patients two sponges were placed. None of the patients (24 of them operated on between April 2, 2012 and February 8, 2013) with TachoSil placed intraoperatively had any signs of postoperative wound infection. Carotid artery stenosis is a very common disease the incidence of which increases proportionally with age of the population observed. Bleeding is a relatively common and significant complication following surgical treatment, particularly in case of arterial bleeding. Bleeding and other complications in the neck can be very serious and challenging for surgical treatment. With the present guidelines for the administration of clopidogrel in the evening before surgery, in some circumstances an increased incidence of postoperative hemorrhage or prolonged duration of surgery can be expected. Intraoperative use of hemostatics may reduce the postoperative bleeding complications. Intraoperative application of TachoSil does not increase the rate of postoperative complications such as infection and delayed healing. TachoSil may reduce the rate of postoperative complications in carotid surgery.

Vertebral artery injuries due to cervical spine trauma, although rarely described in the literature, are relatively common. While most of them will remain asymptomatic, a small percentage of patients may suffer life threatening complications. We report a case of the right vertebral artery injury in a patient with fracture of C4 vertebra, successfully treated with endovascular approach. A 78-year-old male patient was hospitalized for cervical spine injury caused by falling off the tractor. Radiological assessment revealed fracture of C4 vertebra with proximal two-thirds of C4 body dislocated five millimeters dorsally. Significant swelling of soft prevertebral tissues distally of C2 segment was also present. During emergency surgery using standard anterior approach for cervical spine, excessive bleeding started from the injured right vertebral artery. Bleeding was stopped by tamponade with oxidized regenerated cellulose sheet and C4-C5 anterior fixation; then partial reduction of displacement was done. Fifteen days later, after angiography, endovascular repair of the right vertebral artery was performed using percutaneous stent graft. Follow up computed tomography scan angiography showed valid stent patency without contrast extravasation. In cases of cervical spine trauma, surgeon should always be prepared to manage injury of vertebral artery. Bleeding can primarily be stopped by hemostatic packing, and definitive repair can be successfully achieved by endovascular approach using percutaneous stent graft.

Carotid body paraganglioma has considerable malignant potential and locally aggressive behavior, so it should be treated as soon as it is discovered.We report the case of 60-year-old male patient with a carotid body paraganglioma (Shamblin group II) that was causing the carotid arteries to spread. Angiography showed 1 dominant feeding artery arising from the right external carotid artery. Selective angiography was performed 2 days before surgical removal of the tumor, and the feeding artery was successfully embolized with coils.Literature review reveals previous reports where preoperative embolization of the feeding arteries was done using ethanol, polymers, or other liquid agents. In our case, angiography (via femoral artery) was performed 2 days before surgical removal of the tumor, and the main feeding artery (a single branch arising from external carotid artery) was successfully embolized with coils rather than liquids.Performing coil embolization before operating reduced subsequent blood loss and made it easier to identify the feeding artery during surgery. Supraselective coiling, although as difficult as embolization with liquids, may reduce the incidence of postoperative stroke. At 1 year after surgery, the patient had no signs of tumor recurrence.

The objective of this survey was to identify the importance placed by Croatian-based surgeons on writing scientific manuscripts and publishing them internationally, as well as their awareness of and attitudes toward medical writing. A link to an online survey was sent to 327 Croatian-based orthopedic and trauma surgeons. The electronic questionnaire consisted of rating scales, multiple choice questions and free text reply boxes. A total of 61 surgeons based in Croatia replied to the survey, yielding a response rate of 19% (61/327). The survey results indicate that surgeons in Croatia are active in both research and the writing of manuscripts. There is also a high level of interest among them to publish internationally in English to further their careers. While 68% (38/56) of respondents initially claimed to know about medical writing, further questioning on the subject revealed a reduced level of familiarity with the concept. Only 19% (11/58) of respondents had ever engaged the services of a medical writer and they were generally satisfied with the work done across the three areas of language, editing and scientific knowledge. Medical writers are advised to increase awareness of their services among Croatian-based orthopedic and trauma surgeons who may well have a need for their expertise.

We demonstrate the full counteracting ability of stable gastric pentadecapeptide BPC 157 against KCl-overdose (intraperitoneal (i), intragastric (ii), in vitro (iii)), NO-system related. (i) We demonstrated potential (/kg) of: BPC 157 (10ng, 10μg ip, complete counteraction), l-arginine (100mg ip, attenuation) vs. L-NAME (5mg ip, deadly aggravation), given alone and/or combined, before or after intraperitoneal KCl-solution application (9mEq/kg). Therapy was confronted with promptly unrelenting hyperkalemia (>12mmol/L), arrhythmias (and muscular weakness, hypertension, low pressure in lower esophageal and pyloric sphincter) with an ultimate and a regularly inevitable lethal outcome within 30min. Previously, we established BPC 157-NO-system interaction; now, a huge life-saving potential. Given 30min before KCl, all BPC 157 regimens regained sinus rhythm, had less prolongation of QRS, and had no asystolic pause. BPC 157 therapy, given 10min after KCl-application, starts the rescue within 5-10min, completely restoring normal sinus rhythm at 1h. Likewise, other hyperkalemia-disturbances (muscular weakness, hypertension, low sphincteric pressure) were also counteracted. Accordingly with NO-system relation, deadly aggravation by L-NAME: l-arginine brings the values to the control levels while BPC 157 always completely nullified lesions, markedly below those of controls. Combined with l-arginine, BPC 157 exhibited no additive effect. (ii) Intragastric KCl-solution application (27mEq/kg) - (hyperkalemia 7mmol/L): severe stomach mucosal lesions, sphincter failure and peaked T waves were fully counteracted by intragastric BPC 157 (10ng, 10μg) application, given 30min before or 10min after KCl. (iii). In HEK293 cells, hyperkalemic conditions (18.6mM potassium concentrations), BPC 157 directly affects potassium conductance, counteracting the effect on membrane potential and depolarizations caused by hyperkalemic conditions., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Treatment of a mangled lower extremity represents a major challenge. The decision whether to amputate or attempt reconstruction is currently based upon surgical evaluation. The aim of this paper is to propose a new approach to surgical evaluation based on scoring systems, local clinical status of the patient as well as comorbidities, mechanism of trauma and hospital resources. Available literature regarding this topic was evaluated and a case of patient with mangled extremity is presented. Based on current literature guidelines and evidence-based medicine, management for borderline cases is proposed to aid clinical decision making in these situations. We describe a 44-year old male patient who presented with mangled lower left leg. Despite a borderline Mangled Extremity Severity Score (MESS), due to the overall health status of the patient and local clinical status with preserved plantar sensitivity and satisfactory capillary perfusion, reconstruction was attempted. After 6 months of treatment, all wounds healed completely with no pain, and satisfactory motor and sensory function was achieved. In conclusion, the treatment of mangled extremity treatment should be based on evidence based literature along with a clinical evaluation of every individual patient. Scores are helpful, but should not be taken as the sole indication for amputation.

Unlabelled: Reconstruction of the ACL (anterior cruciate ligament) requires precise anatomical placement of the tendon graft. Anatomic variations may increase/decrease risk of the ACL rupture. Twenty-eight children with clinical, MRI and arthroscopic verified ACL ruptures were compared with match case control group. MRI was done one to 12 months after trauma. The thresholds values for identifying the ACL rupture were set; ACL angle < 45 degrees, Blumensat angle > 0 degrees, and the PCL angle < 115 degrees., Results: There was no significant difference of tibial attachment for the ACL and measured parameters of the femur. The ACL angle (p < 0.001), the Blumensat angle (p = 0.001), and the PCL angle (p < 0.001) were significantly different. Each of the patients in group with a torn ACL had at least one parameter positive., Discussion: ACL angle, Blumensat angle and PCL angle might help to diagnose ruptured ACL. Pediatric patients with the ruptured ACL show no difference in notch width or the tibial roof inclination angle as compared with pediatric patients without ACL rupture.

Blunt shoulder trauma rarely causes damage to either arteries or nerves. Neurovascular structures are covered by muscles and protected by the surrounding bones deep in the axilla. We report a case of a 34-year-old male motorbike driver referred to us 5 hours after injury. Standard X-ray of the left shoulder revealed multipart fracture of the left scapula, and angiography showed that the first segment of the left axillary artery was dissected proximal to the minor pectoral muscle. Urgent diagnosis using imaging techniques and restoration of blood flow using open or endovascular repair are crucial for optimal outcome. Damage to the nerves predicts the final functional outcome regardless of prompt revascularization., (Copyright © 2011 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)

The authors present a case of inflammatory malignant fibrous histiocytoma located in the left retroperitoneum. The tumor was resected enblock with kidney and suprarenal gland. During the resection the system of retractors called the pillars of Kocman was used which allowed wide exposure of the abdominal cavity. The tumor measured 23 x 17 x 10 cm with the left kidney and suprarenal incorporated. The tumor was centrally pseudocystic made of xanthomatous cells, foamy cells and rare giant cells with storiform formations and infiltrated with neutrophils. Imunohistochemically, the tumor cells were vimentin and CD 68 positive and CD 20, CD3, EMA, S-100, HMB 45, CD 34 and CD 1a negative. Neutrophils were CD 15 positive.

Thallium is a naturally occurring trace element, widely distributed in the earth's crust, but at very low concentrations. It does not have a known biological use and does not appear to be an essential element for life. It has been considered one of the most toxic heavy metals.Occasionally, there are reports on thallium poisoning as results of suicide or murder attempt or accident. The main threat to humans is through occupational exposure, environmental contamination, and accumulation in food, mainly in vegetables grown on contaminated soil. Increasing use in emerging new technologies and demanding high-tech industry constantly raise concern about exposure risk to all living organisms. Thallium is considered a cumulative poison that can cause adverse health effects and degenerative changes in many organs. The effects are the most severe in the nervous system. The exact mechanism of thallium toxicity still remains unknown, although impaired glutathione metabolism, oxidative stress, and disruption of potassium-regulated homeostasis may play a role. The lack of data about mutagenic, carcinogenic, or teratogenic effects of thallium compounds in humans calls for further research.

We focused on abdominal aorta, clamped and transected bellow renal arteries, and aortic termino-terminal anastomosis created in Albino male rats. We suggested stomach cytoprotection theory holding endothelium protection and peptidergic anti-ulcer cytoprotection therapy to improve management of abdominal aorta anastomosis and thrombus formation. The stable gastric pentadecapeptide BPC 157 (GEPPPGKPADDAGLV, MW 1419) is a small anti-ulcer peptide efficient in inflammatory bowel disease trials (PL 14736) and various wound treatment, no toxicity reported. After 24 h following aortic termino-terminal anastomosis, we shown that BPC 157 (10 microg/kg) may also decrease formation of cloth after aortic termino-terminal anastomosis and preserved walking ability and muscle strength when given as a bath immediately after aortic anastomosis creation. This may be important since aortic termino-terminal anastomosis is normally presenting in rats with a formed cloth obstructing more than third of aortic lumen, severely impaired walking ability, painful screaming and weak muscle strength. Thereby, the effect of BPC 157 (10 microg/kg) was additionally studied at 24 h following aortic termino-terminal anastomosis. Given at the that point, intraperitoneally, within 3 minutes post-application interval the pentadecapeptide BPC 157 rapidly recovered the function of lower limbs and muscle strength while no cloth could be seen in those rats at the anastomosis site.

Aim: The aim of the study was to investigate the pattern of transfusion in patients with pertrochanteric femoral fracture, and to compare the results obtained with literature data., Methods: It was a retrospective study including 246 consecutive patients operated on for pertrochanteric femoral fracture at University Hospital for Traumatology in Zagreb from January 1, 2001 to December 31, 2003. The analysis included the method of operative treatment, type of anesthesia, physical status according to the American Society of Anesthesiology (ASA), preoperative hemoglobin levels, use of thromboprophylaxis, transfusion, and mortality., Results: There were 246 patients with pertrochanteric femoral fracture; 244 (99.2%) underwent surgery and only 2 (0.8%) were treated conservatively. The method of treatment was DHS in 90.2%, and gamma nail in 8.9% of patients. Most patients were classified as ASA II, III and ASA IV (26.4%, 54.9% and 18.7%, respectively), and most were operated on in spinal anesthesia. Thromboprophylaxis with low molecular weight heparins was administered to 98.4% of patients. The mean preoperative hemoglobin was 120 (88-152) g/L, and estimated blood loss during surgery was 300 (100-500) mL. Transfusion of packed erythrocytes was administered 135 (54.9%) patients, 62 (25.2%) during surgery. Fifteen (6.1%) patients received transfusion of blood plasma., Discussion: Fractures in trochanteric region usually occur at age over 60 (80% of patients). Due to the patients' cardiovascular status the "transfusion trigger" remains undefined. Even relatively small alterations of the circulating volume make intraoperative blood pressure control rather challenging., Conclusion: The preoperative level of hemoglobin, clinical status of the patient, type of surgery, and anesthesia are useful predictors of transfusion therapy in patients with pertrochanteric hip fracture.

Aim: Thromboembolism (TE) is a well-known and potentially fatal complication after injury and orthopedic surgery. Thromboembolic prophylaxis is generally recognized as a factor of significant interest concerning posttraumatic comorbidity and mortality. In this context, the aim of the study was to analyze hospital mortality 24 hours after injury, and to assess the proportion of fatal pulmonary embolism in overall hospital mortality. Finally, the purpose of the study was to explore the possible correlation between different prophylactic approaches and hospital mortality., Methods: A retrospective-prospective study was conducted at the University Hospital of Traumatology, Zagreb, over a 14-year period (1988-2001). The study was based on documented clinical and autopsy findings and comprised all trauma patients admitted for hospital treatment. The overall and thromboembolic mortality were analyzed for each individual year during the study period. These two variables were compared and expressed as a proportion for each year. Further analysis included comparison of the data obtained between years and sequences of years. The modes of TE prophylaxis in various periods were analyzed as well. Differences in the mortality rates were tested for statistical significance. Results obtained for each period of time were compared and expressed as a function of different approaches to thromboembolic prevention., Results: Results obtained in the study demonstrated a clear tendency towards the decrease in the overall mortality as well as in the mortality due to fatal pulmonary embolism. Mortality rates showed significant differences during the study period. The most prominent difference was found between the first and final year of investigation. In 1988, the overall mortality was 3.78% and TE mortality 2.05%, whereas in 2001 the respective rates were 1.17% and 0.3% (p < 0.001). A continuous significant mortality decrease in trauma patients was recorded for some years and sequences of years (p < 0.05). The proportion of TE fatality in the overall mortality was > 50% in 1988 and about 25% in 2001. Our results demonstrated a 70% reduction in the overall mortality and even 85% reduction in the fatal TE rate. Finally, a significant reduction of TE fatality by 55% independently of overall mortality reduction was observed. The decreasing mortality rate correlated with different approaches to TE prophylaxis during the 14-year-period., Discussion: Thromboembolism accounted for a considerable proportion of the mortality rate in trauma patients during the study period. The observed dynamics, expressed as a 70% reduction in the overall hospital mortality and an 85% decrease in the fatal PE rate reflected significant improvement in trauma treatment. Further, independently of the overall mortality, TE mortality was reduced by more than 55%, which was obviously related to the changing approaches to TE prevention. At the beginning, physical methods of prophylaxis prevailed. Prophylactic anticoagulation with heparin was started sporadically around 1991 and have been enhanced over time. In 1995, it was included in the routine treatment of specific patient categories. Since 1998, low molecular weight heparin has become the gold standard in TE prophylaxis, with more prominent application in severe multiple injuries. With the recent approach, we have managed to overcome the controversies in the treatment of severe injuries, primarily concerning bleeding and TE, and achieved considerable improvement., Conclusion: A significant reduction in the mortality, especially due to fatal pulmonary embolism after injury, was clearly demonstrated. This could be explained by improvements in the management of trauma and organized TE prevention.

Aim: Like any other operative procedure, the implantation of hip prosthesis is associated with certain complications, which diminishes the value and purpose of such a procedure. One of the complications in artificial hip implantation is loosening of the alloplastic material. Therefore, the aim of this study was to examine the effect of lubrication on the torsional moment and its role in the loosening of the femoral component, using an experimental mechanical model. The following hypothesis was tested: the magnitude of torsional loading in the "bone-endoprosthesis-bone cement system" is similar to any other known loading., Methods: The testing device was constructed with the possibility of simulation of positions similar to original performances in the implanted hip prosthesis. It refers primarily to the possibilities of achieving definite forces and velocities. The intention was to point quantitatively to the role of friction moment between the acetabular and femoral endoprosthesis part. Trials were conducted by combining 7 types of loading and 4 kinds of lubrication: dry, water, plasma, and light oil. The testing joint (Ring's prosthesis) was connected through tensometric measuring shaft upon the working forepart oscillating mechanism. Graded by the changeable static loading by means of the pendulum and via lever mechanism the testing joint was loaded by force from 610 to 7137 N. As the cause of friction resistance in the moving joint, torque deformaties of the measuring shaft occurred. The testing joint enabled oscillating movement using a four-part mechanism. In this way, it was possible to define not only the maximum values of the frictional moment (or the coefficient of friction) during one movement cycle but also to examine its relation to the kind of lubrication. Change in the measuring torsional moment were computer recorded. Before each trial, the gauging of the complete outfit was performed. Thereafter, cleaning of the frictional surfaces of the whole outfit was done., Results: The results obtained in combination with lubrication showed a slight increase in the values of the frictional moment. With dry lubrication and greater loading, an extremely progressive gradient of change was recorded. The course of change in the coefficient of friction was essentially different from the course of change in the frictional moment. It was noted particularly during trials with lubrication. In trials without lubrication, a constant increase of loading (force) resulted in a progressive increase in the coefficient of friction, similar to the friction moment. Such a character of the friction moment increase in the observed loading field was explained by the presence of boundary friction in cases with lubrication and by dry friction in cases without lubrication. In dry friction, scratching occurs relatively early, at a loading of F = 1854 N. It occurs with substances of approximately the same hardness like Ring's prosthesis, where the acetabular and femoral prosthesis parts are of metal characteristics., Conclusion: The increase in the frictional moment within the observed loading range can be explained by the presence of bordering friction in cases with lubrication, and of dry friction in cases without lubrication. Contrary to this, dry friction relatively early leads to "scratching", especially when sparing materials of similar hardness are combined.