[Liver injuries--personal experience with treatment].

BACKGROUND: Trauma is one of todays most serious and expensive health care problems, and it is the most common cause of mortality in young population. Non-operative tretment is standard strategi for menagment of blunt liver injuries in hemodynamically stable patiens in last decade. METHODS: Retrospective study included patiens with liver trauma, admitted in the period december 1995 - december 2005, in total 476. RESULTS: 392 of 476 patients presenting with liver trauma had blunt and only 84 had penetrating injury. Isolated liver injury was identified in 27.5% and 72.5% had associated injuries. Average ISS value was 24.06 (SD = 14.26).During the operation liver injury in patients was classified according to Moor. In 2% critical patients, due to hemodynamic unstability we performed "damage control surgery". Out of 476 patients 8.7% were successfully managet, 6.1% died as "mors in tabula" or during first 24 hours and 6.9% died during hospitalization. CONCLUSION: Higher proportion of nonoopertively treated is among patients with ISS less thanand those with injuries grade I end II.

Evaluation of the Alvarado score in the diagnosis of acute appendicitis.

This study has been performed in the Emergency center, Clinical centre of Serbia, during the period 01.03.2007-01.09.2007. We performed this study on 57 patients with diagnosis suspected for acute appendicitis (ages 16-70). Parameters that make the Alvarado score are the following: migration of pain, anorexia, nausea or vomiting, right lower abdominal quadrant tenderness, rebound tenderness in right iliac fossa, elevated temperature, leukocytosis, shift to the left of neutrophils. The aim of the work is to evaluate the Alvarado scoring system in diagnosis of the acute appendicitis. With all the patients Alvarado score has been determinate preoperatively, and diagnosis was confirmed by intraoperative finding and histopatological examination of the removed appendix. All the patients with score 7 or more were surgically managed. Specificity (positive predictive value) was 92.59 % in males and 76.67 % in females. The negative appendectomy rate was 7.41 % with the males and 23.33 % with the females. The values of the Alvarado score are significantly higher in the patients with acute appendicitis, compared with the patients of the other diseases. With the application of the Alvarado scoring system we can decrease postoperative morbidity and mortality.

[Surgical perspectives in treatment of bleeding peptic ulcers].

Peptic ulcer bleeding has overall incidence of 50 to 150 on 100.000 grown-ups per year and represents cause for over 1% of all urgent hospitalization today. Despite of the evolution of the endoscopic diagnostics and haemostasis, improved intensive care and surgical treatment, overall mortality is still over 10% (operative treatment over 20%), and it almost hasn't changed over past 40 years. For more than 100 years surgery had major role in treatment of peptic bleeding ulcers, whereas nowadays it is limited to treatment of its complications. Adequate surgical treatment demands properly timed operation, safest but appropriate operation and trained surgeon. Early surgery is much better compared to the last minute surgery. At high risk rebleeding ulcer, early delayed surgery appears to be adequate, since the complications and lethal outcome are more frequent in this group.