Management of war penetrating craniocerebral injuries during the war in Croatia.

From September 1991 to December 1992, during the war in Croatia, the General Hospital in Slavonski Brod served as an evacuation centre. During that period 197 patients with war-related penetrating craniocerebral injuries were admitted. They were analyzed according to wound characteristics, operability, mortality, operative and post-operative complications, and their condition after hospital discharge and follow-up. A less aggressive surgical approach was accepted in our surgical strategy, recommended in recent studies, followed by an aggressive intensive management. All patients received antibiotics ("war scheme") and anticonvulsants. Early results of treatment do not differ significantly from other recent studies (Vietnam, Israel) in respect to both mortality and complications. Follow-up was difficult. Most of the patients were Bosnia and Herzegovina citizens who were refugees and banished to foreign countries; thus their addresses were unknown. They are consequently lost to follow-up. A less aggressive surgical approach proved to be justified. Routine use of antibiotics and anticonvulsants lowered the infection rate and early seizure incidence to an acceptable level. Late seizure incidence is similar to those previously reported.

[Combined homicide-suicide]. / Kombinirana ubojstva-samoubojstva.

Although the rate combined homicide-suicide is low compared with that for suicide alone or homicide, homicide-suicide generates much public concern. In some cases, the homicide-suicide involves annihilation of an entire family or multiple people. The phenomenon is difficult to study in part because the perpetrator is dead and unavailable for psychiatric assessment. It is nonetheless crucial to attempt to advance our understanding of this tragic phenomenon. The literature review addresses demographic variables, proposes two classifications, one based on psychopathology, the other on the relationship between offender and victim. In attempting to understand the acts of homicide-suicide, inquiry into the following dimensions should be useful: Ego weakness. What type of psychopathology may have contributed to the homicidal-suicidal behavior? Stressors. What type of acute and chronic stressors did the individual experience leading up to this act? Vectors. Whom did the individual select to kill and why? As contribution to this phenomenon six cases of homicide-suicide had been analyzed in ten year period in the Osijek region.

Reducing the incidence of infection in pediatric cerebrospinal fluid shunt operations.

We reviewed our experience with shunt implantation during two time periods. From June 1985 to December 1990, 201 children with hydrocephalus underwent 382 operations. Among these children 36 (18%) developed a proven shunt infection, with an incidence rate per procedure of 9.4%. As a result of this study, a new effective protocol for shunt procedures involving modifications to the perioperative (antibiotic prophylaxis) and intraoperative management (meticulous surgical technique, complete shunt revision) of children undergoing initial shunt implantation or revision was initiated. With this new protocol 75 children underwent a total of 112 procedures between January 1991 and December 1995. The incidence of shunt infection decreased, with a per patient rate of 8% and a per procedure rate of 5.3%. The majority of infections in our study were caused by Staphylococcus epidermidis, which was found in 22 (52.3%) patients.

View of a war from a pathology department: Croatian experience.

This report presents an analysis of autopsy records from the Department of Pathology and Forensic Medicine, Osijek General Hospital, in the period from 2 May 1991, when 12 Croatian policemen were killed in an ambush in Borovo Selo and the war against Croatia unofficially began, until 15 January 1992, when the last cease-fire agreement between Croatia and Serbia, sponsored by the United Nations, became effective. During that time, 651 war-related autopsies were performed, constituting 42 per cent of all the deaths recorded in eastern Slavonia for that period. This number presents an 11-fold increase in the number of violent deaths in comparison to the same period of the pre-war year 1989 to 90. Forty-four per cent of all deaths were civilian ones. Explosive wounds were the most frequent cause of death: they accounted for 60 per cent of the civilian and 49 per cent of all the deaths. This fact and the extensive destruction of the cities in eastern Slavonia, including their hospitals, indicate that a principal characteristic of this and many modern wars is sudden and unexpected ground and air attacks on civilian targets.

[The civilian massacre in Dalj on 1 August 1991]. / Pokolj civila u Dalju 1. kolovoza 1991.

On August the 1st, 1991, Yugoslav Federal Army and Serbian terrorists attacked the village of Dalj, near Osijek in Eastern Slavonia. The civilians took refuge in Osijek and Hungary, but many of them were captured by terrorists. Their fate is still unknown, and the number of missing persons is more than 300. The Federal Army denies the entry to the village and permitted only 25 cadavers to be taken to the Osijek Hospital. Two out of 25 were civilians: P. D., a baker of Albanian origin, and N. T., baker's assistant, a Croat. The decedent N. T. was killed from the back by rifle fire, while the decedent P. D. was first beaten and then executed by two close-range gunshots in the head.

[Civilian massacre near Podravska Slatina, 3 September 1991]. / Pokolj civila blizu Podravske Slatine 3. rujna 1991.

Twenty one civilians, 5 women and 16 men, were found dead in their doorways and yards after Serbian terrorists attacked the village of Cetekovac on 3 September 1991. The age of the decedents ranged from 18 to 91 years. The oldest victims were women (aged 63, 68, 72, 86 and 91). The wounds found on 19 decedents were characteristic of the long-range gunshot wounds, with projectiles fired mostly from the back or/and the side of the body. The autopsy of one decedent (J. B.) revealed that he died from two stabbing wounds and that those were the only wounds inflicted to the body. The body of the decedent (M. S.) was heavily carbonized so that the cause of the death or even whether he was alive when his body was set on fire could not be estimated.

Homicide-suicide by stabbing.

It is rare that an assailant kills someone and afterward commits suicide by stabbing himself on the scene. This report describes how a young soldier killed his young girlfriend and then killed himself.

[Lipoleiomyoma of the uterus]. / Lipoleiomyoma uteri.

A case of lipoleiomyoma uteri in a 44-year old women is presented. The tumor, 9 cm in diameter, was situated beneath the serous membrane, at the back wall. There were also smaller leiomyomas, but the tumour described differed from them in being pale-yellow and having a somewhat softer consistency.