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Objective: The purpose of this retrospective study was to describe and analyze casualties in mine-clearance operations in South Croatia from 1991 to 1995. During the war in Croatia, the laying of mines by both sides was largely unplanned, without mapping or documentation, making demining, an already expensive, complicated task, even more dangerous.Methods: The study comprised all those injured in mine-clearance operations treated at Clinical Hospital Split. The type of mines used, the mechanism of the incident, and the location and severity of injury according to the Abbreviated Injury Scale and the Injury Severity Score were analyzed.Results: In a 5-year period, 160 pyrotechnicians of the Croatian Army performed demining in Southern Croatia. In 29 incidents, 53 deminers were injured. The degree of injury according to the Abbreviated Injury Scale was 2.85 +/- 0.6 and Injury Severity Score grade was 19.68 +/- 8.57. Two of the injured died.Conclusion: To find and remove approximately 2 million mines laid in Croatia will take at least 10 years and 2,000 to 3,000 specialized personnel. Unfortunately, the results of the study demonstrate that a significant number of deminers will suffer grave injuries or die in the process. [ABSTRACT FROM AUTHOR]

Objective: Antitank mines inflict devastating injuries that are usually fatal. The objective of this retrospective study was to analyze antitank mine casualties in South Croatia during the period from 1991 to 1995.Methods: Mechanism, degree of injury according to Abbreviated Injury Scale and Injury Severity Score, as well as surgical treatment were analyzed.Findings: Of 464 mine victims, 42 (9.0%) patients sustained antitank mine injuries, and 12 of these were fatal (29%). Abbreviated Injury Scale of the antitank mine injuries was 5.3 +/- 10.6. Military personnel were injured in 29 cases, and civilians were injured in 13 cases.Conclusion: Although injuries from antitank mines were ravaging, and frequently fatal, a significant number of patients survived. [ABSTRACT FROM AUTHOR]

Objectives: In this retrospective study, antipersonnel mine casualties in Southern Croatia from 1991 to 1995 are analyzed and treatment options are discussed.Methods: Mechanism, degree of injury according to Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS), as well as surgical treatment were analyzed.Results: Of a 2,693 war trauma population, 422 (15.67%) patients sustained antipersonnel mine injuries, 241 (57.11%) from pressure mines and 181 (42.89%) from fragmentation mines. Military personnel were injured in 329 cases, civilians in 60 cases, and children in 33 cases. AIS was 3.01 +/- 0.56 and ISS was 17.92 +/- 6.59. Of 39 fatalities (9.24%) with a mean age of 27.98 +/- 1.70 years, 34 were soldiers, 4 were civilians, and 1 was a child. AIS was 5.35 +/- 0.39 and ISS was 54.94 +/- 2.36.Conclusion: Fatalities and morbidity arising from antipersonnel mines can be reduced by the provision of appropriate surgical and evacuation facilities at the actual battlefield. [ABSTRACT FROM AUTHOR]

In this paper, a capacitive method for characterization of LTCC tapes in the frequency range between 1kHz and 1MHz using HP 4277A LCZ meter is presented. The principle of operation using a parallel plate capacitor and equivalent circuit as a parallel connection of capacitance and a resistor is explained and characterization of test samples is measured. The fabrication process in LTCC technology and the causes that can produce the changing of characteristic parameters of substrates in fabrication are explained in detail. We indicated the importance of knowing permittivity in the function of frequency during projecting and simulating electronic components and circuits in LTCC technology. Measurements of complex permittivity, loss tangent, Q-factor based on the proposed formulas are made for LTCC tapes samples. Small variation of measured capacitance and loss tangent is obtained, approximately about 2% in whole frequency range. The value of loss tangent is approximately the same as the value specified by manufacturers. The calculated parameters for complex permittivity have bigger values then those recommended by manufacturers before firing. In the process of sintering, sheet density and microstructure of commercial tapes are changed for all used materials, causing changes of electric characteristics, especially permittivity. In the low frequency range, below 50 kHz, there is a higher variation of characteristic parameters. In this range, the parallel resistance of the equivalent circuit is on the top level of the instruments limit and these results are not reliable. A specific user-friendly program is developed which enables automatic control of measurement, recalculation of important values and processing of results.

Microfluidic technology, which involves the manipulation of fluids in microchannels, faces challenges in channel design and performance optimization due to its complex, multi-parameter nature. Traditional design and optimization approaches usually rely on time-consuming numerical simulations, or on trial-and-error methods, which entail high costs associated with experimental evaluations. Additionally, commonly used optimization methods require many numerical simulations, and to avoid excessive computation time, they approximate simulation results with faster surrogate models. Alternatively, machine learning (ML) is becoming increasingly significant in microfluidics and technology in general, enabling advancements in data analysis, automation, and system optimization. Among ML methods, Bayesian optimization (BO) stands out by systematically exploring the design space, usually using Gaussian processes (GP) to model the objective function and guide the search for optimal designs. In this paper, we demonstrate the application of BO in the design optimization of the microfluidic systems, by enhancing the mixing performance of a micromixer with parallelogram barriers and a Tesla micromixer modified with parallelogram barriers. Micromixer models were made using Comsol Multiphysics software® and their geometric parameters were optimized using BO. The presented approach minimizes the number of required simulations to reach the optimal design, thus eliminating the need for developing a separate surrogate model for approximation of the simulation results. The results showed the effectiveness of using BO for design optimization, both in terms of the execution speed and reaching the optimum of the objective function. The optimal geometries for efficient mixing were achieved at least an order of magnitude faster compared to state-of-the-art optimization methods for microfluidic design. In addition, the presented approach can be widely applied to other microfluidic devices, such as droplet generators, particle separators, etc.

Although various sensors specifically developed for target analytes are available, affordable biosensing solutions with broad applicability are limited. In this study, a cost-effective biosensor for detecting human epidermal growth factor receptor 2 (HER2) was developed using custom-made gold leaf electrodes (GLEs). A novel strategy for antibody immobilization on a gold surface, for the first time mediated by protein L and HER2-specific antibody trastuzumab, was examined using commercial screen-printed gold electrodes and GLEs. A self-assembled monolayer of 11-mercaptoundecanoic acid (MUA) was formed on the gold surface, which was used to covalently immobilize protein L. Further binding of trastuzumab to the protein L was employed and HER2 detection was achieved through electrochemical impedance spectroscopy (EIS). The HER2 detection was examined in phosphate-buffered saline (PBS) and supplemented cell culture medium. The modified GLEs showed good specificity and high sensitivity of HER2 detection without any enrichment steps, achieving a limit of detection (LOD) of 1 ng mL - 1 in PBS and 2.7 ng mL - 1 in cell culture medium, making the proposed immunosensor a cost-effective and sensitive solution for detection in complex biological matrices., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Gold electrodes are one of most prevalent substrates in electrochemical biosensors because they can be easily and highly efficiently functionalized with thiolated biomolecules. However, conventional methods to fabricate gold electrodes are costly, time-consuming and require onerous equipment. Here, an affordable method for rapid fabrication of an electrochemical immunosensor for Escherichia coli detection is presented. The gold electrode was generated using 24-karat gold leaves and lowcost polyvinyl chloride adhesive sheets covered with an insulating PTFE layer. The goldleaf electrode (GLE) was patterned using laser ablation and characterized by cyclic voltammetry, electrochemical impedance spectroscopy, scanning electronic microscopy, contact angle and 3D profiling. The GLEs were modified by a self-assembled mercaptopropionic monolayer, followed by surface activation to allow binding of the specific anti-E. coli antibody via carbodiimide linking. The biosensor showed a detection limit of 2 CFU/mL and a linear dynamic range of 10-10 7  CFU/mL for E. coli cells. No false positive signals were obtained from control bacteria. The obtained results demonstrated suitability of GLE for use in biosensors with high reliability and reproducibility. It is foreseeable that our work will inspire design of point-of-need biosensors broadly applicable in low-resource settings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

In recent years, advancements in microfluidic and sensor technologies have led to the development of new methods for monitoring cell growth both in macro- and micro-systems. In this paper, a microfluidic (MF) platform with a microbioreactor and integrated impedimetric sensor is proposed for cell growth monitoring during the cell cultivation process in a scaled-down simulator. The impedimetric sensor with an interdigitated electrode (IDE) design was realized with inkjet printing and integrated into the custom-made MF platform, i.e., the scaled-down simulator. The proposed method, which was integrated into a simple and rapid fabrication MF system, presents an excellent candidate for the scaled-down analyses of cell growths that can be of use in, e.g., optimization of the cultivated meat bioprocess. When applied to MRC-5 cells as a model of adherent mammalian cells, the proposed sensor was able to precisely detect all phases of cell growth (the lag, exponential, stationary, and dying phases) during a 96-h cultivation period with limited available nutrients. By combining the impedimetric approach with image processing, the platform enables the real-time monitoring of biomasses and advanced control of cell growth progress in microbioreactors and scaled-down simulator systems.

The connection of macrosystems with microsystems for in-line measurements is important in different biotechnological processes as it enables precise and accurate monitoring of process parameters at a small scale, which can provide valuable insights into the process, and ultimately lead to improved process control and optimization. Additionally, it allows continuous monitoring without the need for manual sampling and analysis, leading to more efficient and cost-effective production. In this paper, a 3D printed microfluidic (MF) chip for glucose (Glc) sensing in a liquid analyte is proposed. The chip made in Poly(methyl methacrylate) (PMMA) contains integrated serpentine-based micromixers realized via stereolithography with a slot for USB-like integration of commercial DropSens electrodes. After adjusting the sample's pH in the first micromixer, small volumes of the sample and enzyme are mixed in the second micromixer and lead to a sensing chamber where the Glc concentration is measured via chronoamperometry. The sensing potential was examined for Glc concentrations in acetate buffer in the range of 0.1-100 mg/mL and afterward tested for Glc sensing in a cell culturing medium. The proposed chip showed great potential for connection with macrosystems, such as bioreactors, for direct in-line monitoring of a quality parameter in a liquid sample.

Electrochemical biosensors utilizing nanomaterials have received widespread attention in pathogen detection and monitoring. Here, the potential of different nanomaterials and electrochemical technologies is reviewed for the development of novel diagnostic devices for the detection of foodborne pathogens and their biomarkers. The overview covers basic electrochemical methods and means for electrode functionalization, utilization of nanomaterials that include quantum dots, gold, silver and magnetic nanoparticles, carbon nanomaterials (carbon and graphene quantum dots, carbon nanotubes, graphene and reduced graphene oxide, graphene nanoplatelets, laser-induced graphene), metal oxides (nanoparticles, 2D and 3D nanostructures) and other 2D nanomaterials. Moreover, the current and future landscape of synergic effects of nanocomposites combining different nanomaterials is provided to illustrate how the limitations of traditional technologies can be overcome to design rapid, ultrasensitive, specific and affordable biosensors.

In this paper, a microwave microfluidic sensor based on spoof surface plasmon polaritons (SSPPs) was proposed for ultrasensitive detection of dielectric constant. A novel unit cell for the SSPP structure is proposed and its behaviour and sensing potential analysed in detail. Based on the proposed cell, the SSPP microwave structure with a microfluidic reservoir is designed as a multilayer configuration to serve as a sensing platform for liquid analytes. The sensor is realized using a combination of rapid, cost-effective technologies of xurography, laser micromachining, and cold lamination bonding, and its potential is validated in the experiments with edible oil samples. The results demonstrate high sensitivity (850 MHz/epsilon unit) and excellent linearity (R 2 = 0.9802) of the sensor, which, together with its low-cost and simple fabrication, make the proposed sensor an excellent candidate for the detection of small changes in the dielectric constant of edible oils and other liquid analytes.

Meat cultivation via cellular agriculture holds great promise as a method for future food production. In theory, it is an ideal way of meat production, humane to the animals and sustainable for the environment, while keeping the same taste and nutritional values as traditional meat and having additional benefits such as controlled fat content and absence of antibiotics and hormones used in the traditional meat industry. However, in practice, there is still a number of challenges, such as those associated with the upscale of cultured meat (CM). CM food safety monitoring is a necessary factor when envisioning both the regulatory compliance and consumer acceptance. To achieve this, a multidisciplinary approach is necessary. This includes extensive development of the sensitive and specific analytical devices i.e., sensors to enable reliable food safety monitoring throughout the whole future food supply chain. In addition, advanced monitoring options can help in the further optimization of the meat cultivation which may reduce the currently still high costs of production. This review presents an overview of the sensor monitoring options for the most relevant parameters of importance for meat cultivation. Examples of the various types of sensors that can potentially be used in CM production are provided and the options for their integration into bioreactors, as well as suggestions on further improvements and more advanced integration approaches. In favor of the multidisciplinary approach, we also include an overview of the bioreactor types, scaffolding options as well as imaging techniques relevant for CM research. Furthermore, we briefly present the current status of the CM research and related regulation, societal aspects and challenges to its upscaling and commercialization.

Periprocedural myocardial injury (PMI) and contrast-induced nephropathy (CIN) are frequent complications of percutaneous coronary intervention (PCI) associated with early and late major adverse cardiovascular events. Both conditions are associated with similar risk factors, which could imply their possible association. The aim of our study was to assess the correlation of PMI and early postprocedural creatinine shift (ECS) as a marker of renal injury.A total of 209 hospitalized patients with stable coronary artery disease (CAD) were enrolled, who underwent an elective PCI in a period of 12 months. All patients had their serum high-sensitivity troponin I (hsTnI) measured at baseline and 16 hours after the PCI. PMI was defined according to the elevation of postprocedural hsTnI using criteria provided by both the most recent consensus documents as well as evidence-based data. Renal injury was evaluated using the ECS concept. Serum creatinine (SCr) was also measured at baseline and at 16 hours. ECS was defined as SCr >5% at 16 hours compared to baseline.Although incidence of both PMI (77.5%) and ECS (44.5%) were high, no association of these 2 conditions could be found. Further analyses of our data showed that diabetes is associated with a higher incidence of ECS, while patients on beta-blocker therapy had a lower incidence of ECS.In our study, no association between PMI and ECS was found. Additional studies with a larger number of patients and longer patient observation are needed to assess the correlation between PMI and CIN as well as to validate the attractive, but controversial, concept of ECS as an early marker of CIN.

Microfluidics, one of the most attractive and fastest developed areas of modern science and technology, has found a number of applications in medicine, biology and chemistry. To address advanced designing challenges of the microfluidic devices, the research is mainly focused on development of efficient, low-cost and rapid fabrication technology with the wide range of applications. For the first time, this paper presents fabrication of microfluidic chips using hybrid fabrication technology-a grouping of the PVC (polyvinyl chloride) foils and the LTCC (Low Temperature Co-fired Ceramics) Ceram Tape using a combination of a cost-effective xurography technique and a laser micromachining process. Optical and dielectric properties were determined for the fabricated microfluidic chips. A mechanical characterization of the Ceram Tape, as a middle layer in its non-baked condition, has been performed and Young's modulus and hardness were determined. The obtained results confirm a good potential of the proposed technology for rapid fabrication of low-cost microfluidic chips with high reliability and reproducibility. The conducted microfluidic tests demonstrated that presented microfluidic chips can resist 3000 times higher flow rates than the chips manufactured using standard xurography technique.

Foodborne pathogenic bacteria present a crucial food safety issue. Conventional diagnostic methods are time-consuming and can be only performed on previously produced food. The advancing field of point-of-need diagnostic devices integrating molecular methods, biosensors, microfluidics, and nanomaterials offers new avenues for swift, low-cost detection of pathogens with high sensitivity and specificity. These analyses and screening of food items can be performed during all phases of production. This review presents major developments achieved in recent years in point-of-need diagnostics in land-based sector and sheds light on current challenges in achieving wider acceptance of portable devices in the food industry. Particular emphasis is placed on methods for testing nucleic acids, protocols for portable nucleic acid extraction and amplification, as well as on the means for low-cost detection and read-out signal amplification., Competing Interests: The authors declare no conflict of interest.

In this paper, we propose a novel microwave microfluidic sensor with dual-sensing capability. The sensor is based on a dual-mode resonator that consists of a folded microstrip line loaded with interdigital lines and a stub at the plane of symmetry. Due to the specific configuration, the resonator exhibits two entirely independent resonant modes, which allows simultaneous sensing of two fluids using a resonance shift method. The sensor is designed in a multilayer configuration with the proposed resonator and two separated microfluidic channels-one intertwined with the interdigital lines and the other positioned below the stub. The circuit has been fabricated using low-temperature co-fired ceramics technology and its performance was verified through the measurement of its responses for different fluids in the microfluidic channels. The results confirm the dual-sensing capability with zero mutual influence as well as good overall performance. Besides an excellent potential for dual-sensing applications, the proposed sensor is a good candidate for application in mixing fluids and cell counting., Competing Interests: The authors declare no conflict of interest.

Table of Contents: A1 Point-of-care ultrasound examination of cervical spine in emergency departmentYahya Acar, Onur Tezel, Necati SalmanA2 A new technique in verifying the placement of a nasogastric tube: obtaining the longitudinal view of nasogastric tube in addition to transverse view with ultrasoundYahya Acar, Necati Salman, Onur Tezel, Erdem CevikA3 Pseudoaneurysm of the femoral artery after cannulation of a central venous line. Should we always use ultrasound in these procedures?Margarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA4 Ultrasound-guided supraclavicular subclavian vein catheterization. A novel approach in emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA5 Clinical ultrasound in a septic and jaundice patient in the emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA6 Characterization of the eyes in preoperative cataract Saudi patients by using medical diagnostic ultrasoundMustafa Z. Mahmoud, Abdelmoneim SuliemanA7 High-frequency ultrasound in determining the causes of acute shoulder joint painMustafa Z. MahmoudA8 Teaching WINFOCUS Ultrasound Life Support Basic Level 1 for Providers in resource-limited countriesAbbas Ali, Alrayah Mustafa, Ihab Abdelrahman, Mustafa Bahar, Osama Ali, H. Lester Kirchner, Gregor ProsenA9 Changes of arterial stiffness and endothelial function during uncomplicated pregnancyAjda Anzic, Paul LeesonA10 Cardiovascular haemodynamic properties before, during and after pregnancyAjda Anzic, Paul LeesonA11 An old man with generalized weaknessMaryam Bahreini, Fatemeh RasooliA12 Ultrasonography for non-specific presentations of abdominal painMaryam Bahreini, Houman HosseinnejadA13 Introduction of a new imaging guideline for suspected renal colic in the emergency department: effect on CT Urogram utilisationGabriel Blecher, Robert Meek, Diana Egerton-WarburtonA14 Transabdominal ultrasound screening for pancreatic cancer in Croatian military veterans: a retrospective analysis from the first Croatian veteran's hospitalEdina Ćatić Ćuti, Stanko Belina, Tihomir Vančina, Idriz KovačevićA15 The challenge of AAA: unusual case of obstructive jaundiceEdina Ćatić Ćuti, Nadan RustemovićA16 Educational effectiveness of easy-made new simulator model for ultrasound-guided procedures in pediatric patients: vascular access and foreign body managementIkwan Chang, Jin Hee Lee, Young Ho Kwak, Do Kyun KimA17 Detection of uterine rupture by point-of-care ultrasound at emergency department: a case reportChi-Yung Cheng, Hsiu-Yung Pan, Chia-Te KungA18 Abdominal probe in the hands of interns as a relevant diagnostic tool in revealing the cause of heart failureEla Ćurčić, Ena Pritišanac, Ivo Planinc, Marijana Grgić Medić, Radovan RadonićA19 Needs assessment of the potential utility of point-of-care ultrasound within the Zanzibar health systemAbiola Fasina, Anthony J. Dean, Nova L. Panebianco, Patricia S. HenwoodA20 Ultrasonographic diagnosis of tracheal compressionOliviero Fochi, Moreno Favarato, Ezio BonanomiA21 The role of ultrasound in the detection of lung infiltrates in critically ill patients: a pilot studyMarijana Grgić Medić, Ivan Tomić, Radovan RadonićA22 The SAFER Lasso; a novel approach using point-of-care ultrasound to evaluate patients with abdominal complaints in the emergency departmentYoungrock Ha, Hongchuen TohA23 Awareness and use of clinician-performed ultrasound among clinical clerkship facultyElizabeth Harmon, Wilma Chan, Cameron Baston, Gail Morrison, Frances Shofer, Nova Panebianco, Anthony J. DeanA24 Clinical outcomes in the use of lung ultrasound for the diagnosis of pediatric pneumoniasAngela Hua, Sharon Kim, James TsungA25 Effectiveness of ultrasound in hypotensive patientsIsa Gunaydin, Zeynep Kekec, Mehmet Oguzhan AyA26 Moderate-to-severe left ventricular ejection fraction related to short-term mortality of patients with post-cardiac arrest syndrome after out-of-hospital cardiac arrestJinjoo Kim, Jinhyun Kim, Gyoosung Choi, Dowon ShimA27 Usefulness of abdominal ultrasound for acute pyelonephritis diagnosis after kidney transplantationJi-Han LeeA28 Lung ultrasound for assessing fluid tolerance in severe preeclampsiaJana Ambrozic, Katja Prokselj, Miha LucovnikA29 Optic nerve sheath ultrasound in severe preeclampsiaGabrijela Brzan Simenc, Jana Ambrozic, Miha LucovnikA30 Focused echocardiography monitoring in the postoperative period for non-cardiac patientsAsta Mačiulienė, Almantas Maleckas, Algimantas Kriščiukaitis, Vytautas Mačiulis, Andrius MacasA31 POCUS-guided paediatric upper limb fracture reduction: algorithm, tricks, and tipsSharad MohiteA32 Point-of-care lung ultrasound: a good diagnostic tool for pneumonia in a septic patientZoltan Narancsik, Hugon MožinaA33 A case of undergraduate POCUS (r)evolutionSara Nikolić, Jan Hansel, Rok Petrovčič, Una Mršić, Gregor ProsenA34 The Graz Summer School for ultrasound: from first contact to bedside application: three-and-a-half-day undergraduate ultrasound training: résumé after two years of continuous developmentSimon Orlob, Markus Lerchbaumer, Niklas Schönegger, Reinhard KaufmannA35 Usefulness of point-of-care ultrasound in the emergency room in a patient with acute abdominal painAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA36 Use of bedside ultrasound in a critically ill patient. A case reportAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA37 Diagnostic yield of clinical echocardiography for the emergency physicianAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA38 Focused cardiac ultrasound in early diagnosis of type A aortic dissection with atypical presentationChun-I Pan, Hsiu-Yung Pan, Chien-Hung WuA39 Detection of imperforated hymen by point-of-care ultrasoundHsiu-yung Pan, Chia-Te KungA40 Developing a point-of-care ultrasound curriculum for pediatric nurse practitioners practicing in the pediatric emergency departmentSarah Pasquale, Stephanie J. Doniger, Sharon Yellin, Gerardo ChiricoloA41 Use of transthoracic echocardiography in emergency setting: patient with mitral valve abscessMaja Potisek, Borut Drnovšek, Boštjan LeskovarA42 A young man with syncopeFatemeh Rasooli, Maryam BahreiniA43 Work-related repetitive use injuries in ultrasound fellowsKristine Robinson, Clara Kraft, Benjamin Moser, Stephen Davis, Shelley Layman, Yusef Sayeed, Joseph MinardiA44 Lung ultrasonography in the evaluation of pneumonia in childrenIrmina Sefic Pasic, Amra Dzananovic, Anes Pasic, Sandra Vegar ZubovicA45 Central venous catheter placement with the ultrasound aid: two years' experience of the Interventional unit, Division of Intensive Care Medicine, KBC ZagrebAna Godan Hauptman, Marijana Grgic Medic, Ivan Tomic, Ana Vujaklija Brajkovic, Jaksa Babel, Marina Peklic, Radovan RadonicA46 Duplicitas casui: two patients admitted due to acute liver failureVedran Radonic, Ivan Tomic, Luka Bielen, Marijana Grgic MedicA47 A pilot survey on an understanding of Bedside Point-of-Care Ultrasound (POCUS) among medical doctors in internal medicine: exposure, perceptions, interest, and barriers to trainingPeh Wee MingA48 Unusual case of defecation syncopeNur hafiza Yezid, Fatahul Laham MohammedA49 A case report of massive pulmonary embolism; a multidisciplinary approachZainal Abidin Huda, Wan Nasarudin Wan Ismail, W.Yus Haniff W.Isa, Hashairi Fauzi, Praveena Seeva, Mohd Zulfakar Mazlan.

Background: The study was undertaken to identify possible relations between established and novel risk factors for atherosclerosis (gender, age, diabetes mellitus, hypertension, smoking and C-reactive protein) and the possibility of carotid restenosis following carotid endarterectomy (CEA)., Patients and Methods: A prospective study of 193 consecutive patients, admitted electively for carotid endarterectomy during 68 months, was conducted. 131 patients had symptomatic and 62 asymptomatic carotid disease. An attempt was made to follow-up on all operated arteries with duplex sonography at 2 months, 6 months, 12 months, and 24 months postoperatively. The correlation of previously mentioned variables (gender, age, diabetes mellitus, hypertension, smoking and average values of C-reactive protein) with progressive or recurrent disease was determined by chi-square analysis and analysis of variance., Results: Of all 193 examined patients 29 demonstrated increasing degree of artery stenosis, while recurrent artery stenosis of > 69% was diagnosed in 11 patients. Age, gender, hypertension, and diabetes did not play a significant role in the presence of progressive (or recurrent) disease, while active smokers and patients with preoperative and average C-reactive protein (CRP) levels over 3.0 mg/L had a greater propensity to develop progression (or recurrence) of carotid disease., Conclusions: Increased levels of CRP in serum may be a better predictor of carotid restenosis after CEA than other established risk factors for vascular disease--except active smoking.

Background and Aims: The aim of this study was to provide information on the diagnosis and treatment of kinking -- bends in the extracranial internal carotid artery (KICA), a rate but major and treatable cause of cerebral ischemia., Project: A retrospective review of the seven-year experience in Split Hospital. ESSENTIAL DATA: The role of the surgical correction of carotid artery kinking has not yet been precisely defined., Materials and Methods: Of the 86 carotid revascularization operations performed in 76 patients from 1988 to 1994, 21 (29%) patients underwent surgery owing to symptomatic kinking of the internal carotid artery. This group included 8 females and 13 males with a mean age of 57.3+/-5.5 years (range 44-70). Symptoms included cerebrovascular insults in 43%, hemispheric transient ischemic attacks in 33%, reversible ischemic neurological deficit in 24% of patients. The diagnosis was made using two-dimensional ultrasound scan and Doppler, computerised tomography and angiographic evaluation. Two methods were used: the elimination of kinking and graft of the internal artery onto the common carotid artery with excision of the kinked section of the artery and end-to-end anastomosis. Dense fibrous tissues around the kinked artery were removed and the artery was freed along its entire course. The anomalous relationship between the internal carotid artery, occipital artery and hypoglossal nerve was corrected., Results: After surgery seventeen patients fully recovered without neurological complications. One patient died, one patient suffered permanent neurological deficit, two suffered from transient ischemic attacks., Conclusions: Anatomic reconstruction together with the correction and elimination of the affected segments of the carotid artery may prevent progressive cerebrovascular symptoms and is associated with a low morbidity and mortality rate.

We present our experience in the treatment of 1,300 wounded at the Rama war hospital in Bosnia and Herzegovina. Rama surgical teams performed mainly chest, abdominal and vascular operations, and other operations if the patient's life was considered to be in danger. All severely wounded patients were transported in a stable hemodynamic state to the Split University Hospital within 48 to 72 h, as the Rama hospital was primarily an evacuation facility. Owing to the well-organized first aid provided and the rapid evacuation from the combat line, all patients were operated within 3 h after injury. This, together with the excellent functioning of our blood bank were factors responsible for our good results. Among the 226 casualties operated under general anesthesia, mortality was 8.4% (19 cases). The most common causes of death were multiple injury and irreversible hemorrhagic shock.

Objective: This paper reviews military vascular injuries in Southern Croatia., Background: Report of surgical procedures in war-related arterial and venous injuries in association with soft tissue destruction and bone involvement, with its post-operative medical and physical therapy. For vascular surgeons cases are presented, which are seldomly seen in civilian circumstances. For this reason this paper is published., Patients and Methods: A retrospective review was done for 189 wounded (13 females, 175 males) with vascular injuries in the time period from June 1991 through December 1993. Ninety-one (48.1%) of the patients sustained injuries due to explosive weapons (different types of mines, grenades and its fragments). Extensive soft-tissue and bone destruction was associated in 55 (36.2%) wounded. The age ranged from 14 to 63 (mean 27.3) years. The operative techniques involved the debridement of devitalised and infected tissue, prophylactic fasciotomy, the reconstruction of major venous injuries, application of microsurgical techniques in selected cases and the extensive use of autogenous interposition grafts. The wounds were treated by secondary closure and routinely antibiotics were given. In selected cases an arteriography was performed preoperatively. Vascular injury with a prolonged time of ischemia were the most common indication for hyperbaric oxygenation (HBO)., Results: Six (3.2%) patients died from associated severe injuries. In sixteen (15.1%) cases a subsequent amputation had to be performed., Conclusions: The results of this study support the reconstruction of major vessel damage in order to save a limb. Careful and regular follow-up examinations also by other medical specialties proved to enhance a positive outcome for this severely injured patients. We also suggest the extensive use of HBO in war casualties.