[Frangible bullets: wounding capability and clinical aspects of their use]. / Strely frangible: ranivost a klinické aspekty jejich pouzití

The article deals with basic characteristics of the frangible bullets and it documents a very specific behaviour of chosen types of these bullets in testing blocks as a substitute materials of alive tissues. The frangible bullets have several important advantages compared to the classical sorts of firearms bullets. The highest benefit could be seen especially in the limited penetrating capability and very low ricochet hazard connected with the use of these bullets. The absence of poisonous elements in the material of frangible bullets (for instance lead) is highly appreciated from the ecology reasons nowadays as well. The cartridges assembled with frangible bullets are used most of all for the practise reasons by law enforcement units, but can be used very effectively also in combat situations. Results of own shooting experiments confirm that the wound potential of bullet can be changed in a very large extent with the change of the manufacturing technology and the bullets geometry. Newly developed frangible bullets and the already manufactured bullets available on the market are characterized by very specific terminal ballistic features. Some frangible bullets behave in a comparable way to full metal jacketed bullets while penetrating soft tissues. Another frangible bullets of different designs fragment to the pieces in soft tissues and cause very serious wounds with persistent effects. The usage of frangible bullets and a potential risk of misuse of this specific sort of ammunition require also new approaches in the medicine for the treatment of the gunshot wounds.

[A different view of acute upper gastrointestinal bleeding in liver cirrhosis patients]. / Jiný pohled na akutní krvácení do horního trávicího traktu u pacientu s jaterní cirhózou.

OBJECTIVES: The study focuses predominantly on non-varicose sources of acute upper gastrointestinal bleeding in liver cirrhosis patients and aims to determine its mortality. METHODS AND SUBJECTS: The prospective examination included 137 liver cirrhosis patients with acute upper GIT bleeding. All the patients underwent an endoscopic examination. In case of multiple findings, defining the bleeding source was based on the specialist's attitude presented as the conclusion of the endoscopic examination. RESULTS: The most frequent causes of acute bleeding included oesophagus varices (57.7%), followed by peptic gastric and duodenal ulcers (18.2%), then portal hypertension gastropathy (9.5%), gastric varices (5.1%), reflux oesophagitis (2.9%), Mallory-Weiss syndrome (2.9%) and erosive gastropathy (1.5%). The endoscopy of the upper digestive tract resulted in a negative diagnosis in not more than 2.2% of patients. The majority of examinations showed multiple findings in the upper digestive tract, each of which could have been a potential cause of bleeding. Mortality in all bleeding cirrhotic patients reached 14.6%, 18.6% of which were related to the varicose type of bleeding and 7.8% to the non-varicose type. CONCLUSION: Portal hypertension led to bleeding (caused by varices and portal hypertension gastropathy) in 72.3% of patients, 62.8% patients suffered from purely varicose bleeding, 37.2% patients from non-varicose bleeding. Mortality was statistically significantly higher on 0.1 level of significance in cases of varicose bleeding in comparison with non-varicose bleeding. An emphasis should be laid on an early and detailed endoscopic examination leading to an appropriate diagnosis and therapy.

[Endoscopic findings in upper gastrointestinal tract in patients with liver cirrhosis]. / Endoskopické nálezy v horním trávicím traktu u pacientu s jaterní cirhózou.

151 patients suffering from the cirrhosis of the liver underwent a prospective endoscopic examination of the upper digestive tract. The most frequent diagnoses in the group with the cirrhosis of the liver included oesophagus varices (64.9%), portal hypertension gastropathy (45.7%) and the peptic ulcer of the gastroduodenum (25.8%). A normal diagnosis in the endoscopy of the upper digestive tract was found only in 8.6%. Other diagnoses comprised reflux oesophagitis (13.2%), diaphragm hiatus hernia (12.6 %), duodenogastric reflux (8.6 %), gastric antrum erosion (4.6 %), aphthic gastropathy (3.3 %), rhagades of the cardium (2%), gastric polyp (1.3%), mycotic oesophagitis, gastric carcinoma, oesophagus carcinoma and oesophagus achalasy (0.7% each). Further on the study discusses possible causes of the high incidence of peptic ulcers in the patients with the cirrhosis of the liver. All findings are correlated with literary data.

[The etiology of upper gastrointestinal bleeding in patients with liver cirrhosis]. / Príciny akutního krvácení do horního trávicího traktu u pacientu s jaterní cirhózou.

108 patients suffering from the cirrhosis of the liver and acute bleeding into the upper digestive tract underwent a prospective endoscopic examination with diagnostic and therapeutic objectives. The most frequent causes of acute bleeding included oesophagus varices (57.4%) followed by peptic gastric ulcer (13.9%) and peptic ulcer of duodenum (11.1%), then portal hypertension gastropathy (5.6%), gastric varices (4.6%), reflux oesophagitis (2.8%), Mallory-Weiss syndrom (2.8%) and erosive gastropathy (0.9%). The endoscopy of the upper digestive tract in one patient resulted in negative diagnosis. 69% of examinations showed multiple findings in the upper digestive tract, each of which could have been a potential cause of bleeding. To determine the source of bleeding the specialist's attitude presented at the end of the endoscopic examination was taken into consideration. In 67.6% of patients the bleeding was a direct consequence of portal hypertension, in 62% it was caused by varices. The emphasis is put on early and thorough endoscopic examinations aimed at proper diagnosis and therapy.