[Primary liposarcoma of the pericardium]. / Primarni liposarkom perikarda.

A case of primary liposarcoma of the pericardium, an exceptionally rare localization, has been presented. The tumor localized in the region of the left ventricle and connected to the visceral wall of the pericardium was diagnosed in a 38-year old male. Histological, histochemical and immunochemical findings confirmed the diagnosis of the liposarcoma of the pericardium.

[Traumatic rupture of the left hemidiaphragm]. / Traumatska ruptura leve hemidijafragme.

A case of blunt traumatic rupture of the left hemidiaphragm following a traffic accident was presented. On admission the patient complained of a dyspnoea, and the physical examination of the thorax revealed the absence of breathing sound on the left side. A chest radiography and CT scan had shown the presence of the stomach in the left hemithorax. Posterolateral thoracotomy was performed. In the opened hemithorax, the stomach, omentum and small bowel were found to having passed undamaged through a 12 cm tear of the central part of the diaphragm. These abdominal viscera were replaced in the abdomen and the diaphragm was sutured.

[Resection of post-intubation tracheal stenosis]. / Resekcija postintubacijskestenoze vratnog dela traheje.

The management of a patient with post-intubation circumferential stenosis and tracheostomy was presented. Tracheal resection and reconstruction were performed. The length of resection was four centimeters. The tracheostomy was included in the resected part. The problems of tracheal dissection and mobilization and approximation of the tracheal ends due to the anastomosis were presented. The possibilities of the intubation and adequate ventilation across the operative field were shown.

Recognizing, scoring, and predicting blast injuries.

The aim of this study was to find relevant signs and readily available parameters for the recognition of blast injuries and estimation of their severity. The injury severity, estimated by the Injury Severity Score (ISS), Red Cross Wound Classification (RCWC), and experimentally defined Pathology Scoring System for Blast Injuries (PSS/IS) according to Yelverton and modified for use in humans, was compared with a great number of subjective sensations, clinical signs, parameters of hemodynamic, metabolic, neuroendocrine and immune conditions. On the basis of these data, the confidence of the above-mentioned methods was analyzed in the evaluation of blast injuries. This study included 1303 casualties, wounded by explosive devices and with suspected blast injuries, treated at the Military Medical Academy in Belgrade (MMA) from 1991 to 1994. The patients were examined on admission at the MMA (<18 hours) and during hospitalization (1, 2, 5, and 7 days after wounding). The casualties with confirmed blast injury (n = 665, 51%) had an ISS ranging from 0 to 34 (mean 13) had wounds ranging from G1ST (soft tissue wounds caused by low energy transfer) to G3VF (massive wounds with fractures and injury of vital structures) according to the RCWC, with PSS/IS scores from 2 to 105 (mean 60). Statistically significant correlation was found between ISS and PSS/IS as well as RCWC and PSS/IS. Cytokines (IL-1, TNF|ga) and amino acids responded to a blast injury in similar manner as to gunshot wounds with a greater ISS or more severe RCWC injury type. The subjective sensations in blasted patients (deafness, thoracic pain, vertigo) and mediators, confirmed in previous experimental investigations as important factors in the pathogenesis of blast injuries (TxA2, sulfidopeptide leukotrienes) were relationed only to the PSS/IS.

[Staphylococcal pneumonia associated with pneumatoceles, bilateral pyopneumothorax and sepsis]. / Stafilokokna pneumonija pracenja pneumatocelama, obostranim piopneumotoraksom i sepsom.

A case of soldier with community acquired staphylococcal pneumonia and multiple pneumatoceles as the rare complication in adults is presented. Their recognition provides appropriate treatment. In the patient were developed bilateral pneumothorax, pleural empyema and sepsis. Surgical treatment was performed by thoracic drainage. Recovery of pulmonary function was poor, as distinguished from children.

[Hemangiopericytoma of the lungs]. / Hemangiopericitom pluca.

Six patients, three women and 3 men with lung hemangiopericytoma treated at the Military Medical Academy in the period 1971-1991 are reported. The youngest patient was 20 years, the oldest 69 years. Surgical treatment was performed in all patients, 3 lobectomies, one bilobectomy, one wedge resection and one extirpation. Multiple hemangiopericytoma was found in one patient which consisted of three separate tumours in the right lung. The other had solitary lesions. Malignant hemangiopericytoma, was found in 4 patients, one of them had metastases in the mediastinal lymphatic glands. Four patients are alive and are under control for nine years in the average without signs of recurrence.

[Decortication of the lung in the treatment of nonspecific pleural empyema]. / Dekortikacija pluca u lecenju nespecificnih empijema pleure.

In the period 1986-1990 at the Clinic of Cardiac and Thoracic Surgery 86 patients with nonspecific pleural empyema were treated. There were 18 men and one woman, mean age of 35.6 years. Causes of empyema have been the following: pleuropneumonia (10 patients), chest trauma (2), iatrogenic pleural infection (2), spontaneous pneumothorax (2), mediastinitis (1) and pleural infection per continuitatem (2). The authors consider that decortication should be performed as early as possible, immediately after stabilization of acute signs of infection. The optimal time for surgery is from to six hours since the onset of the disease.

[Characteristics of primary blast injuries at the beginning of armed conflict in Yugoslavia in 1991]. / Neke karakteristike primarnih blast povreda u pocetku oruzanog sukoba u Jugoslaviji 1991. godine.

At the beginning of combat operations in Yugoslavia among 290 wounded members of the Y.P.A. and Territorial Defence sent to the treatment at the Military Medical Academy, 60 (20.7%) were with explosive mine wounds. In the group of 12 wounded with rupture of one or both tympanic membranes or with traumatic hearing impairment of various degrees, the chest x-ray was also performed. Radiologic signs characteristic of primary blast injury of the lung were found in a high percentage (42%). A possible relationship of primary auditory and primary nonauditory blast injury was discussed, and it has been concluded that more severe rupture of the eardrum in the injured by mine explosion can suggest the presence of primary blast injuries.

[Mechanical sutures in the management of the stump of the main bronchus]. / Mehanicki sav u zbrinjavanju patrljka glavnog bronha.

In the period 1964-1988 there have been performed 3173 pulmonary resections of which 1261 pneumoectomies. In 952 patients the mechanical suture was placed in the main bronch and standard suture in 309 patients. For mechanical sutures the Soviet UKL-40 or 60 apparatus was used. The bronchial fistula occurred in 9.2% of surgical patients after using mechanical suture and in 36.5% after using standard suture.

[Injuries of the thorax]. / Povrede grudnog kosa.

Within the period of 16 years (1973-1988) 692 patients with chest injuries were treated at the Military Medical Academy or 7% of all hospitalized patients with trauma. The largest source of trauma was traffic accidents (431 or 62.3%). Thoracotomy was performed in only 32 (4.6%) patients and the total mortality was 6.9% (48 traumatized). The importance of early recognition of vitally threatening syndromes and immediate initiation of therapeutical measures for correction of the disturbed intrathoracal relationship and hypovolemia have been pointed out.