[BASIC PRINCIPLES OF SURGICAL TREATMENT OF CHRONIC WOUNDS ­ SHARP DEBRIDEMENT].

The ever improving health standards in terms of quality and more efficient health care result in an increase in life expectancy, thus increasing the number of elderly people in the population. A higher level of activity in elderly population leads to greater incidence of injuries, and on the other hand, there is an increasing number of comorbidities. Circulatory disorders, diabetes mellitus, metabolic imbalances, etc. and a reduced biological potential of tissue regeneration result in an increased number of chronic wounds that pose a significant health, social and economic burden on the society. These conditions require significant involvement of medical and non-medical staff in pre-hospital institutions. Significant material and other health care resources are allocated for the treatment of chronic wounds. These conditions result in a lower quality of life of patients and their families and caregivers. Debridement is a crucial medical procedure for the treatment of acute and chronic wounds. The result of debridement is removal of all barriers within and around the wound that obstruct physiological processes of wound healing. Debridement is a repeating process when indicated. There are several types of debridement, each with its advantages and disadvantages. The method of debridement should be determined by the physician or other professional trained person on the basis of wound characteristics and in accordance with their expertise and capabilities. In the same wound, we can combine different types of debridement, all with the goal of faster and better wound healing.

Suicide and the war in Croatia.

Analyzing data from the Institute of Forensic Medicine (IFM) in Rijeka, a total of 853 suicides were recorded in a 15 years period (1986-2000). Quantitative and qualitative features of suicides were analyzed in three intervals: pre-wartime, wartime and post-wartime. In the wartime period (1991-1995), the suicide rate increased by 20.9% in comparison with the pre-war period. In the post-wartime period, the suicide rate dropped by 26.2% in comparison with the war period. The results show a significant increase in suicide rates in the wartime. During the wartime period, a large number of suicide victims under the age of forty increased-45.3% in comparison with the pre-war period and 56.6% in comparison with the post-war period. The use of firearms as a means of committing suicide quadrupled during the war in comparison with the pre-war period. The level of alcohol intoxication of perpetrators at the moment of suicide significantly increased in the wartime period. War had a direct impact on quantitative and qualitative characteristics of suicides in Croatia.

Perforin expression is upregulated in the epidermis of psoriatic lesions.

BACKGROUND: There are currently very few data regarding the role of cell-mediated cytotoxicity in psoriasis. Both cytotoxic T lymphocytes and natural killer (NK) cells mediate cytotoxicity reactions, mainly by two distinct pathways, the perforin/granzyme and the Fas/Fas ligand pathway. OBJECTIVES: To study the expression and distribution of perforin, T- and NK-cell subsets in psoriatic lesional and nonlesional skin. METHODS: Skin biopsy specimens from both lesional and nonlesional skin of 11 patients with chronic plaque psoriasis and eight healthy controls were analysed by immunohistochemistry. RESULTS: We found a significant increase in CD4+ and CD8+ cells in psoriatic lesions compared with nonlesional and healthy skin. The expression of CD16+ NK cells was significantly lower in lesions compared with healthy skin. Perforin expression was significantly enhanced in the epidermis of psoriatic lesions. CONCLUSIONS: Perforin expression is upregulated in the epidermis of psoriatic lesions, suggesting a potential role for perforin in the creation of the psoriatic plaque.