Ochratoxin A in corn and wheat: geographical association with endemic nephropathy.

AIM: To determine the presence and concentration of ochratoxin A in wheat and corn from Slavonski Brod surroundings, the area of endemic nephropathy allegedly caused by ochratoxin. METHODS: Thin-layer chromatography was used to determine ochratoxin A concentrations in 92 wheat and 51 corn samples from the surroundings of Slavonski Brod, Osijek, Hrvatsko Zagorje, Istria, and Celje (Slovenia). RESULTS: Ochratoxin A was present in 74 of 92 (75.8%) wheat samples and 17 of 51 (33.3%) corn samples, in a concentration range of 0.02-160.00 mg/kg in wheat and 0.02-40.00 mg/kg in corn. Wheat samples from the Slavonski Brod surroundings contained the highest level of ochratoxin A (38.8 +/- 27.2 mg/kg), followed by Osijek (8.7 +/- 8.3 mg/kg). Ochratoxin A levels in the wheat from Hrvatsko Zagorje, Istria, and Celje were considerably lower (2.1 +/- 1.5, 1.3 +/- 2.6 and 0.2 +/- 0.5 mg/kg, respectively). Wheat samples from Slavonski Brod significantly differed from all other sample groups (p < 0.001), and wheat samples from Osijek differed from those from Hrvatsko Zagorje, Istria, and Celje (p < 0.001, p = 0.003, p < 0.001, respectively). Ochratoxin A level was the highest in the corn samples from the Slavonski Brod surroundings (20.0 +/- 14.8 mg/kg) and considerably lower in samples from Osijek, Celje, Hrvatsko Zagorje, and Istria (0.8 +/- 1.4, 0.7 +/- 1.9, 0.4 +/- 0.4, and 0.4 +/- 0.8 mg/kg, respectively). A statistically significant difference was also observed between the Slavonski Brod samples and all other corn samples (p < 0.001). CONCLUSION: Irrespective of the real association between ochratoxin A and endemic nephropathy, our data clearly demonstrate their geographical overlap.

Small countries and the dioxin scandal: how to control imported food?

The aspiration of the countries in transition to join the developed European countries resulted in opening their borders and several-fold increase in import, especially of food products. The imported foods are less expensive than domestic foods, but their quality is often highly questionable. In analyzing the safety of these products for human health, small countries encounter at least two sets of problems. One is related to legal provisions on the parameters to be analyzed, whenever new requirements emerge in practice, like the latest one on dioxin. The other, even more difficult set of problems, is related to the expensive equipment needed for the monitoring of foodstuff safety, the procurement of which exceeds the financial possibilities of these countries. For example, from June 11 until July 31, 1999, during the so-called European dioxin crisis, a total of 58 foodstuffs produced in Belgium, Netherlands, and France between January 19 and March 3, 1999, were referred to the Department of Health Ecology, Zagreb Institute of Public Health, the only laboratory authorized for identification of polychlorinated dibenzodioxins and dibenzofurans in the Republic of Croatia. In 40 samples, the level of dioxin was below the detection limit of 0.5 ng - international toxic equivalents per kg fat (ng-I-TEQ/kg fat), whereas in 18 positive samples the level of dioxin did not exceed the limit of 5 ng-I-TEQ/kg fat for the foodstuff commercial usability. Although highly contaminated products have not yet appeared on the Croatian market, recent developments in Europe have pointed out that establishing an authorized laboratory for dioxins in the Republic of Croatia or in the region is needed.

Neurologic recovery after penetrating craniocerebral war injury.

From June 1, 1991, until December 31, 1992, 116 patients with penetrating craniocerebral war injuries inflicted at the east Slavonian front were treated at the Osijek University Hospital. There were 26 (22.4%) gunshot wounds and 90 (77.6%) wounds inflicted by explosive devices and projectiles. Four years after the injury, a study of the survivors' condition was carried out. No difference was recorded in the survival rate between the patients with gunshot wounds compared with explosive wounds. Rehabilitation produced good results in the survivors, in the prevention of both acute and chronic complications and permanent damage. Older age, lower Glasgow Coma Scale, and level of consciousness were found to be prognostic indicators of outcome.

Fish as an indicator of eco-system contamination with mercury.

AIM: To compare the total and organic mercury content in sea-fish samples from Croatia, where fishing occurs in a closed part of the Mediterranean Sea, and from other countries fishing mostly in the oceans. METHOD: During 1997, we collected at the Zagreb fish market a total of 115 samples of fifteen kinds of fish including bathypelagic, pelagic and elasmobranch fish, caught in the wider coastal areas of Netherlands, Germany, Spain, Argentina, Belgium, and Croatia. Total mercury and organic methyl-mercury in the fish were determined at the laboratory for testing of food and other common use material at the Zagreb Institute of Public Health. Total mercury was determined by the method of atomic absorption spectrometry. Methyl-mercury was determined by the method of gas chromatography. The mean annual fish consumption in each country was used to calculate the mean weekly intake of mercury and methyl-mercury in each individual country relative to the recommended values. RESULTS: The mean content of total mercury and organic mercury in pooled samples was 111+100 ug/kg and 95+87 ug/kg (85.6%), respectively. The highest values were found in the fish from Croatia (170+124 ug/kg and 150+107 ug/kg; 88.2%, respectively). This concentration did not exceed the maximal allowed level of 500 ug/kg for total and 400 ug/kg for organic mercury in any of the samples examined. The highest values of total mercury (119+111 ug/kg) and organic mercury (103+96 ug/kg; 86.6%) were found in bathypelagic fish. According to the mean annual per capita fish consumption in each country, the mean weekly mercury intake was highest in Spain (49.8 ug) and lowest in Croatia (19.0 ug. CONCLUSION: At present conditions of mercury content and its mean annual consumption, dietary use of sea-fish can still be recommended, even from the seas with closed circulation, such as Adriatic.

Injuries caused by antipersonnel mines in Croatian Army soldiers on the East Slavonia front during the 1991-1992 war in Croatia.

During the war in Croatia, antipersonnel mines were mostly laid without plan by both sides, with no minefield layout, especially on the East Slavonia front. A group of Croatian disabled war veterans wounded by antipersonnel mines at the East Slavonia front from June 1, 1991, to September 1, 1992, were analyzed. The front line between the Croatian Army units and Serbian paramilitary units mostly ran along a lowland, partially swampy and wooded ground, convenient for large-scale laying of antipersonnel mines, especially so-called surprise mines. Fifty-seven soldiers suffered injuries caused by antipersonnel mines, 27 (47.4%) of them by pressure-activated mines and 30 (52.6%) by pull-action mines. The severity of wounds was assessed according to the Abbreviated Injury Scale (AIS). In the group of patients with wounds inflicted by pressure-activated mines, the mean AIS score was 4.0 +/- 0.7, with injuries to the lower extremities (mostly feet) ranging from foot-mutilating defects to partial lower-leg amputation. In the group of patients with injuries caused by pull-action mines, the mean AIS score was 3.0 +/- 0.9, indicating relatively minor injuries of different types according to the mechanism of wounding and localization. A failure to comply with minelaying regulations made protection impossible and resulted in a relatively high proportion of the wounded. The same problems are now encountered on mine removal. According to estimates, at least 10 years of intensive work of 2,000 to 3,000 trained experts will be required to clear some 2 million mines laid all over the area.

Type, severity, location, and timing of battle casualties in a Croatian Army brigade during an offensive action in 1992.

AIM: To analyze the type, severity, location, and timing of casualties in a Croatian Army brigade during an offensive action against enemy forces of about two infantry battalions timely prepared for defense. METHODS: Casualties were analyzed according to bilateral manpower and equipment conditions, morale, time of the day, weather conditions, type of ground where the action took place, quality of planning and steering the course of the action, and especially the medical help. The action was carried out along one main and two auxiliary directions, including river crossing. The action involved about 1,000 soldiers and took 7 hours. It was divided into three phases: approaching the enemy, direct contact, and self-imposed retreat and evacuation. Medical care for the injured soldiers was organized in echelons, relying on civilian health care institutions. RESULTS: During the action, 92 casualties were recorded. The mean injury severity according to the Abbreviated Injury Scale (AIS) was 2.9+/-1.4. The highest proportion of casualties occurred on the main direction (48 or 52.2%) but the most severe injuries were inflicted on the second auxiliary direction (mean AIS, 2.6+/-1.4). Extremely severe injuries (mean AIS, 2.0+/-1. 4) were recorded on the second auxiliary direction during the phase of retreat after a successfully performed action. However, regarding the whole action, the observed differences did not prove to be statistically significant. CONCLUSIONS: Offensive action was properly planned and successfully led during the first two phases. Evacuation and retreat of the brigade were in part poorly organized. Health care for the soldiers functioned well throughout the action.

Mortality caused by war wounds to the head and neck encountered at the Slavonski Brod Hospital during the 1991-1992 war in Croatia.

From July 1, 1991, until January 1, 1993, a total of 7,720 patients (soldiers and civilians) with war wounds were treated at Dr. Josip Bencevic General Hospital in Slavonski Brod, Croatia. Treatment was provided for 7,043 patients, whereas 677 individuals (8.8%) killed in action (KIA) were examined at the Forensic Department. There were 1,456 patients (18.9%) with head and neck wounds: 1,176 soldiers and 280 civilians. The mortality rate was significantly greater in patients with head and neck wounds (N = 271, 40.0%) than in those with injuries to the thorax (N = 163, 24.1%) and abdomen (N = 62, 9.2%; p < 0.01 for both). During treatment, 188 patients (2.4%) died of wounds (DOW). The DOW mortality was 5.2% (61 of 1,185), 4.0% (41 of 1,026), and 2.9% (25 of 867) for wounds of the head and neck, thorax, and abdomen, respectively. There was no significant difference in the mortality rate between head and neck and thorax wounds: however, the former exceeded the mortality rate recorded for abdominal wounds (p < 0.05). No significant differences were observed between soldiers and civilians with head and neck injuries either in the KIA (205 of 1,176, 17.4% vs. 66 of 280, 23.5%, respectively) or the DOW group (51 of 971, 5.3% vs. 10 of 214, 4.7%, respectively. According to the mechanism of head and neck wounding, there were 1,046 explosive (71.9%), 226 gunshot (15.5%), and 184 other (12.6%) wounds. Lethal outcome was significantly more common in gushot than in explosive wounds (79 of 226, 35% vs. 243 of 1,046, 23.2%; p < 0.01). The proportion of head and neck injuries did not differ significantly from literature reports on recent conventional wars. The site of wounding, i.e., at the battlefield or elsewhere, had no effect on the prognosis of wounds to the head and neck. Gunshot head and neck injuries showed a significantly higher mortality rate.

Injuries in Croatian Army brigade soldiers inflicted in an offensive action during the 1991/1992 war in Croatia.

The type and number of injuries sustained by soldiers of a Croatian Army brigade in an offensive action during the war in Croatia (1991/1992) were analyzed according to the mechanism of wounding. About 1,000 soldiers participated in a 6-hour offensive action in a flat, partially swampy, and wooded area, convenient for large-scale use of antipersonnel mines and other explosive devices. There were 92 casualties in total: 15 soldiers were killed in action and 77 were lightly or severely wounded. The mechanism of wounding included shell fragments in 44 soldiers (47.8%), antipersonnel mines and gunshot projectiles in 14 soldiers each (15.3%), and others (fall, blow, stress, etc.) in 20 soldiers (21.7%). Death was recorded in 1 of 13 soldiers (7.1%) with gunshot wounds, 11 of 44 soldiers (25%) wounded by shell projectiles, and 4 of 14 soldiers (28.5%) wounded by antipersonnel mines. All injuries inflicted by shell fragments were multiple, whereas the type and severity of injury inflicted by antipersonnel mines were directly related to the type of mine. Pressure-activated mines generally caused limited injuries to the lower extremities, ranging from mutilation to amputation. Injuries inflicted by other antipersonnel mines resembled those caused by shell projectiles; however, their severity depends on a number of factors.

Familial epidemic of meningococcal disease.

Two closely related boys from the same house hold (Home 1), aged two and three, were affected with fulminant meningococcal sepsis known as Waterhouse-Friderichsen syndrome. Neisseria meningitidis serogorup B was isolated from their blood and cerebrospinal fluid. The two-year-old boy died one day after the onset of the disease. Epidemiological examination of contacts and pharyngeal swabs were performed in 14 persons from the household, all of them relatives of the affected children, as well as in a number of other contacts. Chemoprophylaxis with cotrimoxazole was simultaneously administered to all contacts. Family histories revealed that two contacts from the household where the patients did not live (Home 2) were inadvertently omitted. Subsequent examinations, following a report of another contagious disease (salmonelosis), revealed that these two persons were Neisseria meningitidis carriers, together with another one in the same household. The carriers most probably caused the infection of a third, five-year-old boy, the deceased boy's brother (Home 1) who also developed fulminant meningococcal sepsis. The failure to take the appropriate prophylaxis led to a prolonged carrier state in the carrier from the second household. Repeated pharyngeal swab sampling revealed two more carriers from both households that had previously been negative. Control of the epidemic was achieved after 5 weeks by repeated and controlled chemoprophylaxis with ciprofloxacin, and by repeated epidemiological examinations, disinfection, and daily health surveillance by the Sanitary Inspectorate. This extremely rare instance of a familial epidemic with three infected persons emphasizes the need for consistent chemoprophylaxis in meningococcal disease contacts.

War injuries to the head and neck.

During the 1991-1992 war in Croatia, 7,043 wounded persons were treated at Dr Josip Bencevic General Hospital in Slavonski Brod. Among them, 728 (580 soldiers and 148 civilians) had war injuries to the head and neck and were admitted to the Department of Otorhinolaryngology and Cervicofacial Surgery. There were 541 (74.3%) patients with head injuries, 117 (16.0%) with neck injuries, and 70 (9.6%) with a combination of head and neck injuries. The wounds were mostly inflicted by shell and bomb fragments (542 wounds, or 74.5%). War injuries of the facial bones were preliminarily or definitively treated. Preliminary treatment was used for the wounds with multifragmentary fractures and extensive soft-tissue defects. Definitive treatment was used in lesions of cervical structures. Immediate exploration of the neck was performed on 84 patients with penetrating neck wounds. Exploration was positive in 49 patients. Concerning long-term complications, two cases of partial paralysis of the cranial plexus and one case each of quadriplegia, hemiplegia, and glottic paralysis were recorded. To our knowledge, primary closure of war wounds to the head and neck (supported by antibiotic therapy) and reconstruction of extensive laryngotracheal injuries with the medial layer of the cervical deep fascia were used for the first time as war surgery procedures.

[Improvement of sanitation conditions in the liberated Croatian regions after the "Storm" campaign--the Lika-Senj County example]. / Asanacija oslobodenih podrucja Hrvatske nakon akcije "Oluja"--primjer Licko-senjske zupanije.

More than 6,000 sq km of the central and southern areas of the Republic of Croatia were liberated by the Storm campaign, August 4-7, 1995. On August 8, 1995, the Ministry of Health sent expert teams to the newly liberated areas, in order to ensure the basic conditions for the displaced persons to return and live there. To describe the public health measures taken we used the example of the Lika-Senj County (3,746 sq km and 71,215 population). Until October 1, 1995, 50 bodies, killed in action, were detected, pathologically and forensically examined, and then buried. Two hundred and thirty-three mostly elderly and sick persons were admitted to the reception center in Gospic; 93 of them returned to their homes, 133 were accommodated with their relatives and friends, and seven were referred for treatment (four of them died). Two hundred and ten cattle carcasses were buried using adequate sanitation measures, whereas 5,575 sheep, 3,138 head of horned cattle, 298 head of hoofed animals and 300 head of other cattle were caught alive. The procedures of disinfection, disinfestation and disodoration were performed in 720 apartments, 2 hotels, 3 schools, one kindergarten, one health care unit, one sports hall and 5 shops. The main water pump was cleared of mines and partially repaired, whereas some 20 water supply objects were placed under surveillance. Three food depots were found and properly treated. The entire territory was closely observed for a possible occurrence of infectious diseases.

Organization and work of medical service during 1992 military operations in north Bosnia (Bosanska Posavina).

During military operations in Bosanska Posavina in 1992, 6,105 soldiers of the army of the Croatian Defence Council (Bosnian Croats and Muslims) were treated at various health care levels: 920 soldiers were killed, 3,258 were heavily wounded, and 1,927 lightly wounded. The treatment was provided in medical units organized on the front line, in the combat area, and in the communication area. On the front line, medical service was organized as battalion units, whereas the area in general was medically covered by the Slavonski Brod Medical Center in Croatia. Slavonski Brod played a key role with surgical treatment of 5,418 wounded, and definitive care was offered to most subjects seeking medical aid. Scarcity of medical personnel on the front lines and long lines of transportation resulted in a 6.5% death rate (354 patients) during transportation from Bosnian battlefields to Slavonski Brod. In contrast, the mortality rate in the Slavonski Brod Hospital was 3.0% (161 patients). Convalescence homes were established in the Slavonski Brod surroundings, whereas specialized health institutions and rehabilitation centers throughout Croatia accommodated those needing advanced treatment.

[Caloric and nutritive value of kindergarten meals in Zagreb from 1988 to 1993]. / Energetska i prehrambena vrijednost obroka u djecjim vrticima grada Zagreba u razdoblju od 1988. do 1993. godine.

In the 1988-1993 period the mean energy value of meals in 24 Zagreb kindergartens was 4,161.63 kJ or 110.46 of the recommended standard (3,768 kJ). In the same time, the mean protein value 39.53 g/day amounted to 117.13% of the recommended amount of 33.75 g/day. The mean fat value was 139.04% of the recommended amount of fat (32.25 g) or 44.84 g/day. The mean amount of carbohydrate was 107.97 g/day, which was 95.97% of the standard (112.50 g/day). In the 1988-1990 period, the mean energy value of meals was 4,242 kJ or 112.66% of the recommended standard. In the same period, the mean protein value of 39.87 g/day amounted to 118.13% of the recommended. The mean fat value was 128.70% of the recommended amount of fat (32.25 g) or 45.37 g/day. The mean amount of carbohydrate was 111.75 g/day, which was 99.33% of the recommended values. In the 1991-1993 period, the mean energy value of meals was 4,102 kJ or 108.88% of the standard. With a mean amount of the 39.10 g/day, protein was represented by 115.85% of the standard. The mean amounts of fat and carbohydrate also considerably increased to 44.39 and 106.13 g/day or 125.92% and 94.33% of the standard, respectively. In 10 (41.6%) kindergartens (240 meals in total) normal value et least one out of the four parameters measured was not obtained throughout the period of observation.

[Protection of adolescents against hepatitis A]. / Zastita adolescenata protiv hepatitisa A.

In Croatia, hepatitis A is still a considerable public health problem which, however, can be efficiently solved by vaccination. The study of vaccine immunogenicity and reactivity was performed in a random sample of 88 high school seniors, mean age 209 +/- 6.4 month (17 years and 5 months), from Ivanic-Grad and surrounding countyside. All the children were immunized by HAV sorbate SSW inactivated vaccine, manufactured by Sächsisches Serumwerk GmbH, Dresden. One 1-ml dose of the vaccine contains at least 720 units of inactivated HAV, MRC 5 strain, grown on human diploid cells and adsorbed on 0.95 mg aluminium hydroxide gel. The vaccine was administered intramuscularly, according to the scheme 0, 30, 60. Postvaccinal reactions were followed for 3 days after each dose and were observed in four (4.6%) children. A month after last dose (day 90), a 100% seroconversion was found. In 84 (95.5%) children, the level of antibodies exceeded 100 IU/L, one (1.1%) child had 80 IU/L, two (2.3%) children had 50 IU/L, one (1.1%) child had only 20 IU/L.

Work of the Slavonski Brod General Hospital during the war in Croatia and Bosnia and Herzegovina in 1991-1992.

Between September 1, 1991, and December 31, 1992, 7,043 wounded persons, 4,566 of them heavily wounded, were treated at the Slavonski Brod General Hospital. There were three characteristic periods in the work of the hospital during the war. Until March 31, 1992, the hospital provided care for the wounded from the east- and west-Slavonian fronts, at the level of the fourth echelon. The second period started with war actions in Bosanska Posavina and Bosnia and Herzegovina, when the Slavonski Brod General Hospital was the only place offering appropriate care to the wounded from the area. During that period, surgical professions and, to a limited extent, conservative professions were working at the hospital. The third period began with the fall of Bosanska Posavina, toward the end of October 1992, and lasted until the end of the year. During that period, the number of the wounded and previously surgically treated at the Tolisa War Hospital, in the unoccupied area of Bosnia and Herzegovina, admitted to the Slavonski Brod General Hospital, decreased. The total mortality rate in the treated subjects was 2.66%, whereas during the war in Bosanska Posavina it was 3.0%. Throughout the war, there was no interruption in the work of hospital conservative professions, although the extent of their work was reduced.

Medical corps support to a brigade action during an offensive action including river crossing.

This paper describes medical support to a Croatian Army brigade of 2,100 soldiers in an attack combined with river crossing during the 1991/1992 war in Croatia. Three crossings across the river, 4,000 to 5,000 m apart, were used along a front of a total width of 14 km. The anticipated depth of the attack was about 4 km. It was estimated that the enemy had about 1,000 fortified soldiers supported by a corresponding number of artillery and other weapons. The medical corps were strengthened for this particular action by manpower and boats, and the soldiers by additional medical accessories (bandages and triangular slings). During the action, 78 Croatian Army soldiers were wounded, 7 were killed, and 8 were missing. The condition of the wounded soldiers did not worsen during transport. The mean duration of the transport was 90 minutes (maximum 2 hours). Twenty-six percent of the wounded were definitively treated by the brigade medical corps. One physician was included among the seriously wounded. The enemy had more than 150 dead and about 300 wounded. Upon achievement of the planned objectives, the action was interrupted by a high command decision and the brigade returned to its initial position.

Formation and organization of military medical service at the east Slavonia front in the 1991/1992 war in Croatia.

The work of the Croatian Army medical service of the Osijek Military District between July 1, 1991, and September 1, 1993, was analyzed. In the former Yugoslavia, Croatia was not allowed to have its own army. Therefore, the national armed force and medical corps had to be formed during the war against Croatia. Medical support to army units was initially provided by civilian medical services, i.e., by mobile surgical teams performing their tasks on the model of civilian ambulance services. Numerous objective obstacles, such as the lack of equipment, qualified military medical professionals, and experience in the organization and functioning of army medical corps, were encountered. Seventy-five members of the Osijek Military District medical service were killed, wounded, or missing. There were 145,410 recorded and treated cases of various diseases, 21,767 (14.6%) of them referring to war wounds. Forty-three medical vehicles were demolished and 20 were damaged. At present, transformation of the Croatian Army to a peacetime organization is under way.

[Immunity against hepatitis A in younger age groups and the basis for an immunization program]. / Imunitet na HAV mladih dobnih skupina osnova za program imunizacije.

The naturally acquired immunity to hepatitis A virus (HAV) in a sample of 305 children, aged up to 15 years, in the municipality of Ivanic-Grad amounted to 18.7%. The study was conducted in September 1989. Of those 305 children, 16.8% of the boys and 20.7% of the girls were positive. No statistically significant difference was observed with regard to sex (p < 0.01) (chi 2 = 1.4). Of the children aged up to two years, 47.4% were exposed to the hepatitis A virus. Seropositive for anti-HAV were 8.3% in the group from 2-3 years of age, 6.4% in those aged from 4-5 years, 15.9% in the group from 6-7 years of age, 6.8% in those aged from 8-9 years, 20.0% in the group from 10-11 years of age, 27.8% in those aged from 12-13 years, and 29.0% in the group from 14-15 years of age. The spread of the infection by contact was predominant, reflecting the socioeconomic standards of the studied community (p < 0.01) (chi 2 = 29.5). A relatively high prevalence of hepatitis A infection compared to that of the developed countries, the first peak immunity rates in first-graders, a low number of cases among infants aged up to 5 years (approximately 6.0%), availability of commercial vaccine, speak in favour of including hepatitis A vaccination into the obligatory community-wide immunization program. It appears that the target age for HAV vaccination would be the age of five.

[Analysis of the frequency, types and justification for radiographic examination based on a sample of a community population]. / Analiza ucestalosti, vrsta i opravdanosti rendgenskih pregleda na primjeru stanovnika jedne opcine.

According to the patient's general practitioner files of the Health centre "Josip Adamic" Ivanic-Grad, all x-ray diagnostic examinations carried out in health insured persons of the Ivanic-Grad community were analyzed between 1983 and 1987. During the period, a total of 22,615 x-ray examinations were done. An average number of 0.761 radiographs was performed and the average x-ray dose to which patients were exposed was 126.62 mrads (1.26 mGy). The site of most usual examination was the thorax (44.1%). Males underwent more x-ray examinations than females (53.2% versus 46.8%). X-rays of thorax, head and neck, arms and legs were more frequent in males, while abdomen and pelvis x-ray examinations and diascopies were more usual in females. The greatest number of x-ray examinations was performed between the ages of 0 to 20 years of age, and patients were exposed to the highest x-ray dose between the ages of 41 to 60 years of age. The average gonadal dose was 58.78 mrads (0.58 mGy) per year. Clinical examinations preceded radiologic examinations in 81.3% of cases, laboratory investigations in 9.7% and other non-radiologic examinations in 1.4% of cases. The working diagnosis existed before x-ray examination in 77% of cases and pathological findings were discovered in 32.7% of cases.