[Challenge of limb care after violence and war with a special focus on imaging procedures]. / Herausforderung der Extremitätenversorgung nach Gewalt und Krieg mit besonderer Betrachtung bildgebender Verfahren.

BACKGROUND: Injury patterns in the area of the extremities following violence and war harbor many special features and require special attention. Destructive and complex defect injuries are often present, which necessitate elaborate and special reconstruction approaches, predominantly as part of a staged and multistaged procedure. RESEARCH QUESTION: In this context, special attention must be paid to the diagnostic options as an essential aspect, as a clear diagnosis means that targeted treatment steps can be planned and implemented. MATERIAL AND METHOD: The authors' experience in this field from military operations in Afghanistan, Iraq, the Republic of Mali, Kosovo and Georgia, as well as the core content of the Terror and Disaster Surgical Care (TDSC®) course on this topic, have been contextualized and incorporated. In addition, aspects of interdisciplinary cooperation with radiological and, in particular, nuclear medicine disciplines are taken into account in the daily routine. RESULTS AND DISCUSSION: Extremity injuries in the context of violence and war are accompanied by complex bone and surrounding soft tissue defects due to the high energy impact. The principles of reconstruction familiar from everyday life can only be transferred one-to-one to a limited extent. The treatment pathways are often very long and complex and the questions of infection and tissue vitality must be answered again and again in stages. Interdisciplinary collaboration with the disciplines specialized in imaging procedures, particularly in the field of nuclear medicine, is one of the key building blocks for a successful treatment pathway.

[Microbiological challenges in the treatment of war injuries]. / Mikrobiologische Herausforderungen bei der Versorgung von Kriegsverletzungen.

The treatment of war injuries represents a continuing and recurrent challenge in modern reconstructive surgery. Previously, tumor resections and sepsis-related resections were mainly responsible for lengthy bone defects in Germany. In recent years another picture has increasingly emerged, particularly caused by the medical support of Ukraine. Aspects of military surgery are also becoming more important in civil hospitals, especially in the treatment of gunshot and explosion injuries. In Germany, war injuries are currently secondarily treated, as the distribution of patients is carried out according to the cloverleaf principle, weeks or months after the occurrence of the primary injury. In addition to complex bone and soft tissue defects of the extremities following such injuries, which often affect neural and vascular structures, reconstruction is often complicated by an increasing spectrum of multidrug-resistant pathogens. The definition of microbiological terms, such as contamination, colonization, critical colonization, local and systemic infections are important in the clinical routine in order to initiate a targeted treatment, especially in treatment with antibiotics. Wound swabs for determination of the spectrum of pathogens and the optimal testing of resistance are important for selecting the appropriate antibiotic agents. The concept of antibiotic stewardship (ABS) is established in many hospitals to improve the quality of antibiotic treatment and to minimize the formation of resistance. The selection of the method of reconstruction depends on the condition of the patient, the overall clinical constellation and the function to be expected after completion of treatment. The treatment of injuries due to violence and terrorism necessitates clear concepts and an interdisciplinary approach, especially with respect to microbiological challenges and increasing resistance situations.

[Current mortality from war injuries-A narrative review]. / Aktuelle Mortalität von Kriegsverletzungen ­ eine narrative Übersichtsarbeit.

BACKGROUND: The war in Ukraine has led to a strategic reorientation of the German Armed Forces towards national and alliance defense. This has also raised the need for medical and surgical adaptation to scenarios of conventional warfare. In order to develop appropriate and effective concepts it is necessary to identify those war injuries that are associated with a relevant primary and secondary mortality and that can be influenced by medical measures (potentially survivable injuries). OBJECTIVE: The aim of this selective literature review was to identify war injuries with high primary and secondary mortality. METHODS: A selective literature review was performed in the PubMed® database with the search terms war OR combat AND injury AND mortality from 2001 to 2023. Studies including data of war injuries and associated mortality were included. RESULTS: A total of 33 studies were included in the analysis. Severe traumatic brain injury and thoracoabdominal hemorrhage were the main contributors to primary mortality. Injuries to the trunk, neck, traumatic brain injury, and burns were associated with relevant secondary mortality. Among potentially survivable injuries, thoracoabdominal hemorrhage accounted for the largest proportion. Prehospital blood transfusions and short transport times significantly reduced war-associated mortality. CONCLUSION: Control of thoracoabdominal hemorrhage has the highest potential to reduce mortality in modern warfare. Besides that, treatment of traumatic brain injury, burns and neck injuries has a high relevance in reducing mortality. Hospitals of the German Armed Forces need to focus on these requirements.

["PLASTICS" DURING THE WAR OF "IRON SWORDS" - THE ROLE OF A SPECIALIST IN PLASTIC AESTHETIC AND RECONSTRUCTIVE SURGERY].

INTRODUCTION: A war usually requires a new or adjusted set up and needs of all caregivers according to the "new" status. The current war in Israel began on the 7.10.2023. The Israeli Ministries of Defense and Health were in a new status in which they had to complete new requirements according to the use of new weapons, and in numbers and types of injuries that overwhelmed the system from the day the war began. In the past, we published evidence that in times of terror, as in times of war, epidemiology of injuries changes and requires adjustments in human resources, surgical tools and consumables in the Israeli health and defense systems. This article aims to describe the role of specialists in plastic, aesthetic and reconstructive surgery and the first response according to the existing system divided into prevention, preparedness, response and rehabilitation. In the long term rapid response, recruitment of human resources, abilities and flexibility of the system enables overcoming a sudden "new" status as in war, terror and mass casualty events.

Screening and risk factors for cervical cancer among survivors of sexual violence in conflict settings, in Eastern Democratic Republic of Congo.

This study assesses the risk that rape survivors have of developing cervical cancer in the context of conflict. A cross-sectional and descriptive study conducted in Bunyakiri and Kavumu, a conflict region in the east of the Democratic Republic of the Congo during the period from September 1 to 10, 2022, including 47 women survivors of sexual violence, 41 of whom were selected on the basis of certain criteria with age ranging from 18 to 50 years. Speculum examination was performed with visual inspection with acetic acid (VIA). After collecting data, the latter were encoded in the Excel file and grouped in the form of tables then analyzed after calculating the percentage. Ages of 21-30 years was the most represented, i.e., 56%. Among them, 34.1% were married and 31.7% were abandoned. Majority was in secondary school (46.3%) and illiterates (34.1%). 36.5% complained of pelvic pain and 36.5% reported first sexual intercourse at the age range of 13-15 years, of which 25 cases, i.e., 61% were sexually active. 39% reported having had 3 sexual partners in their life. VIA was negative in 97.5% of cases. It should be mentioned in this study that the environment of conflict zone, the circumstances of rape and the risky sexual behavior of survivors are an ecosystem that predisposes them to cervical cancer.

Cette étude évalue le risque qu'ont les survivantes de viol de développer un cancer du col de l'utérus dans un contexte de conflit. Une étude transversale et descriptive menée à Bunyakiri et Kavumu, région de conflit à l'est de la République Démocratique du Congo durant la période du 1er au 10 septembre 2022, incluant 47 femmes survivantes de violences sexuelles, dont 41 ont été sélectionnées sur la base de certains critères avec un âge allant de 18 à 50 ans. L'examen au spéculum a été réalisé avec inspection visuelle à l'acide acétique (VIA). Après collecte des données, ces dernières ont été encodées dans le fichier Excel et regroupées sous forme de tableaux puis analysées après calcul du pourcentage. La tranche d'âge de 21 à 30 ans était la plus représentée, soit 56 %. Parmi eux, 34,1% étaient mariés et 31,7% étaient abandonnés. La majorité était scolarisée dans le secondaire (46,3%) et analphabète (34,1%). 36,5% se plaignaient de douleurs pelviennes et 36,5% rapportaient leurs premiers rapports sexuels entre 13 et 15 ans, dont 25 cas, soit 61% étaient sexuellement actifs. 39 % déclarent avoir eu 3 partenaires sexuels dans leur vie. VIA était négatif dans 97,5 % des cas. Il convient de mentionner dans cette étude que l'environnement de la zone de conflit, les circonstances du viol et le comportement sexuel à risque des survivantes constituent un écosystème qui les prédispose au cancer du col de l'utérus.

Cancer Care to Ukrainian War Refugees in Poland.

This cohort study evaluates cancer care provided to Ukrainian war refugees in Poland.

Reassessing the terminal ballistic performance of trilobate and quadrilobate arrow points on Iron Age battlefields.

In the Eurasian Iron Age arrow points comprise a prominent class of artifact. Projectile experiments are useful for studying the ballistic performance of ancient arrow points and implications of arrow point innovations in warfare and shifting socio politics in Eurasia. However, when projectile experiments are not representative of past weapon use, they can lead to misinterpretations of the archaeological record. Notable problems arise when homogeneous target simulants used in controlled experiments are not representative of the targets past weapons were designed to encounter. This article explores the relationship between arrow point morphology and design choices in the Iron Age using different target media. Shooting arrow points into pottery clay leads to the conclusion that more blades reduced penetrating performance on ancient battlefields, but a very different result obtains by shooting the same points into thick tooling leather as a simulant for leather body armor. The results help explain patterns observed in the Eurasian archaeological record, where trilobate arrow points-initially developed by lightly armored horse archers on the Eurasian steppe-were increasingly adopted by a wide range of societies across Eurasia throughout the Iron Age.

Management of combat-sustained radial nerve injury during World War I: The case of Louis-Ferdinand Céline.

The radial nerve conveys sensory and motor information to and from the upper limb, and radial nerve injury can induce functional disability, as demonstrated by the case of the renowned French writer Louis-Ferdinand Céline (1894-1961), who sustained a gunshot injury to his right arm in October 1914. Radial nerve injuries treated during World War I inspired the publication of several medical handbooks and medical theses, such as that of the military surgeon Major Robert Bretton (1889-1956). The aim of this paper is, via Céline's injury, to explore the management of radial nerve injury during and since World War I. It is important to consider the historical perspective in order to improve radial nerve injury management so as to adapt to modern warfare.

Hybrid warfare and counter-terrorism medicine.

INTRODUCTION: March 9, 2022. An airstrike by Russian forces destroying a maternity hospital in Mariupol, Ukraine. The image of a severely injured pregnant woman covered in blood being stretchered away against the backdrop of destroyed buildings. Mutterings of the use of chemical weapons. This paper is a primer for healthcare personnel and health systems on hybrid warfare and counter-terrorism medicine. DISCUSSION: While recent events and images arising from conflicts around the world represent a cruel hallmark in today's history, attacks against healthcare facilities and innocent civilians are not new and continue to be perpetrated around the world. In war, the Geneva Convention protects civilians and healthcare institutions from harm but when war crimes are being committed and civilians knowingly targeted, parallels from a healthcare perspective can be drawn with terrorism events. Increasingly, civilian institutions and in particular the healthcare sector, are drawn into such conflicts and understanding the health system impact of hybrid warfare and other asymmetrical attack methods is of great importance. CONCLUSION: The field of Counter-Terrorism Medicine (CTM) explores the healthcare impacts of intentional, man-made attacks and much recent research and discussions around this topic are extremely relevant and applicable not just to the ongoing hybrid war in Ukraine, but to today's threat climate all around us.

Ceasefire Declared, but Ethiopian Health Systems Remain in Critical Condition After Civil War.

This Medical News article discusses the total collapse of health care systems in Ethiopia during a 2-year armed conflict.

The kinesthetic diagnosis in a homeric item of pathological heartbeat: An overview in the history of ancient greek medicine.

The Iliad, by the Greek poet Homer, is a precious mine of examples of war traumatology. In the specific case of spear wounds in the chest, the death of the Trojan warrior Alcathous is particularly interesting from the point of view of the history of medicine and the evolution of cardiology and knowledge of the heart at the time of ancient Greece. In particular this paper aims to evidence and reconstruct the main anatomical and physiological knowledge of the heart at that time. Indeed, a historical-linguistic analysis of the Greek text prompts some reflections and thoughts on the heartbeat in pathological conditions and on the function of the heart as a hematopoietic organ. Furthermore, Homer's account is a critical text that highlights the relevance of the use of the senses in the ancient description of nosological pictures and it allows us an interesting and suggestive approach to reconstruction from the historical and historiographical point of view.