The European experience with vascular injuries.

The rich and diverse heritage of the management of vascular injuries in the 45 independent European countries prevents the authors from revealing a uniform picture of the European experience, but some trends are clearly emerging. In countries with a low incidence of penetrating trauma and increasing use of interventional vascular procedures, the proportion of iatrogenic vascular trauma exceeds 40% of all vascular injuries, whereas on other parts of the continent, armed conflicts are still a major cause of vascular trauma. National vascular registries, mostly in the Scandinavian countries, produce useful, nationwide data about vascular trauma and its management but suffer still from inadequate data collection. Despite a relatively low incidence of vascular trauma in most European countries, the results are satisfactory, probably in most cases because of active and early management by surgeons on call, whether with vascular training or not, treating all kinds of vascular surgical emergencies. In some countries, attempts at developing a trauma and emergency surgical specialty, including expertise in the management of vascular injuries, are on their way.

Potential health hazards of cluster bombing in the Shomali Valley, Afghanistan in October-November 2001.

A cluster bomb consists of a canister that opens in mid-air releasing a number of bomblets, which spread over a large area of ground and explode on impact. The exact proportion of bomblets that fail to explode on impact is a matter for debate between military and humanitarian agencies. After the recent bombing of Afghanistan, nine cluster bomb sites in the Shomali Valley were assessed. A total of 317 of 1,818 cluster bomblets had failed to explode (17.4%). Of these 317, 107 (33.7%) had become buried in the ground. Fifty-seven percent of the buried cluster bomblets were embedded deeper than 10 cm. To detect cluster bomblets buried at this depth, large loop metal detectors are needed.