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Biomedical subjects

D Sapunar

Publications and source records attributed to D Sapunar.

18 recordsLinked to original sources
PubMed1998

Clinical and radiological management of wartime eye and orbit injuries.

OBJECTIVE: The purpose of this study is to present our experience in treating 191 patients with eye and orbit injuries that occurred during the war in Croatia and Bosnia and Herzegovina. METHODS: The authors retrospectively reviewed the clinical and radiological management of wartime eye and orbit injuries in patients hospitalized at Clinical Hospital Split. RESULTS: Seventy-nine percent of the war eye and orbit injuries were caused by fragments of explosive devices, 9.9% by high-velocity missiles, and 8.4% by other objects. Most of the patients were admitted to the hospital within 24 hours of injury. The total number of injured globes was 222; 48.2% of globes had intrabulbar (mostly magnetic) foreign bodies, and 13% had extrabulbar intraorbital foreign bodies. Extensive wounds (perforation, double perforation, rupture, and evisceration/ enucleation) were encountered in 74% of patients, and 26% of patients had slight trauma. There was a statistically significant correlation between admission within the first 12 hours and postoperative visual acuity (Chi 2 = 3.93; p = 0.0474). CONCLUSION: Along with clinical examination, computed tomography is the most important diagnostic procedure in preoperative evaluation of various forms of globe and orbit injuries. The admission time is the most important factor in determining postoperative visual acuity.

Adolescent↗
PubMed1998

Surgical treatment of kinked internal carotid artery.

BACKGROUND AND AIMS: The aim of this study was to provide information on the diagnosis and treatment of kinking -- bends in the extracranial internal carotid artery (KICA), a rate but major and treatable cause of cerebral ischemia. PROJECT: A retrospective review of the seven-year experience in Split Hospital. ESSENTIAL DATA: The role of the surgical correction of carotid artery kinking has not yet been precisely defined. MATERIALS AND METHODS: Of the 86 carotid revascularization operations performed in 76 patients from 1988 to 1994, 21 (29%) patients underwent surgery owing to symptomatic kinking of the internal carotid artery. This group included 8 females and 13 males with a mean age of 57.3+/-5.5 years (range 44-70). Symptoms included cerebrovascular insults in 43%, hemispheric transient ischemic attacks in 33%, reversible ischemic neurological deficit in 24% of patients. The diagnosis was made using two-dimensional ultrasound scan and Doppler, computerised tomography and angiographic evaluation. Two methods were used: the elimination of kinking and graft of the internal artery onto the common carotid artery with excision of the kinked section of the artery and end-to-end anastomosis. Dense fibrous tissues around the kinked artery were removed and the artery was freed along its entire course. The anomalous relationship between the internal carotid artery, occipital artery and hypoglossal nerve was corrected. RESULTS: After surgery seventeen patients fully recovered without neurological complications. One patient died, one patient suffered permanent neurological deficit, two suffered from transient ischemic attacks. CONCLUSIONS: Anatomic reconstruction together with the correction and elimination of the affected segments of the carotid artery may prevent progressive cerebrovascular symptoms and is associated with a low morbidity and mortality rate.

Adult↗
PubMed1998

Fibronectin expression in the developing human spinal cord, nerves, and ganglia.

AIM: Analysis of developmental role of fibronectin during differentiation of the human spinal cord, nerves, and ganglia. METHODS: Seven normal human embryos and fetuses between the 7th and 9th developmental week and a 9-week fetus with cervical spina bifida were histologically examined on hematoxylin and eosin stained serial paraffin sections of thoracic axial segments. Monoclonal antibody to the human cell fibronectin fragment was used for immunohistochemical detection of fibronectin. RESULTS: In the 7th and 8th week of development, fibronectin was weakly expressed in the ventricular and intermediate zones of the spinal cord. Intense fibrillar expression was found in the marginal zone of the spinal cord - first over the ventral gray horns and later over the lateral and dorsal gray horns, and along the pathways of ventral and dorsal roots of the spinal nerves and in the spinal ganglia. At 9th week, fibronectin expression disappeared in the ventricular and intermediate zones a nd became weak and granular in the marginal zone of the spinal cord. In the spinal cord of a 9-week malformed fetus with cervical spina bifida, fibronectin expression was completely absent. Fibronectin was expressed in the nerves and ganglia throughout the investigated period, both in normal and malformed human conceptuses. CONCLUSION: Transient expression of fibronectin in the human spinal cord coincided with the most intense neuronal differentiation. Temporal and spatial expression of fibronectin during normal development, and its absence in a malformed human fetus suggests developmental role of fibronectin for the normal formation of the spinal cord.

Biomarkers↗
PubMed1997

War injuries of the femoral artery and vein: a report on 67 cases.

During the war in Croatia (from May 1991 to December 1995), 67 patients with war injuries of the femoral vein and/or artery were treated at the Surgical Clinic of Split Clinical Hospital. All the wounded were admitted directly from the battlefield or from front-line hospitals. There were five women and 62 men with a median age of 29 (range 15-54) years. There were 70 arterial (28 isolated) and 49 venous injuries (six isolated). Forty-six arterial injuries were repaired by reverse vein graft. Four proximal profound femoral arteries were reconstructed. Major venous injuries were repaired, 11 by compilation autogenous vein graft. No synthetic grafts were used. Repair of veins with large defects using compilation saphenous vein grafts gave good results. Six profound femoral veins and two superficial femoral veins were ligated. Vein ligation should be avoided unless another life-threatening injury demands priority. Twenty-one patients required open prophylactic fasciotomy. Two patients died (3%) and three ultimately underwent amputation (5%). Intermittent hyperbaric oxygen therapy was given to 18 heavily wounded patients with beneficial effect. The results support an immediate and coordinated approach to femoral vascular trauma with repair of arterial and venous injuries.

Adolescent↗
PubMed1997

Medical support to a nonprofessional brigade during the Croatian Operation Storm.

A review and description is presented of medical support in the nonprofessional Croatian Home Guard brigade (2,200 soldiers) during the Croatian Operation Storm. Medical support was organized according to a straightforward and easily changeable model that enabled quick adaptations from defense to attack positions. It was provided initially on the front line by company reception units. Further support included battalion aid stations, brigade clearing stations, and the clinical Hospital (fourth echelon) in the nearby city. The brigade medical corps was all volunteers; 9 medical doctors (two women) and 20 medical technicians and nurses. Medical corps assets included a mobile surgical team, eight ambulance vehicles, two spare vehicles, and one helicopter. After one 3-day action, brigade losses were 3 dead, 31 wounded (14 with firearms), and 2 diseased. According to the available data, enemy losses were 25 dead, 4 wounded, 2 sick soldiers, and 48 captured. Transportation time from the battlefield to the hospital was between 60 and 75 minutes. There were no deceased (including enemy soldiers) because of insufficient medical support and/or transportation problems. The applied model of medical corps organization, elaborate preparations, good training, and excellent motivation had a major role in successful treatment of war casualties.

Croatia↗
PubMed1997

Envenomation by the horned viper (Vipera ammodytes L.).

Snake venom poisoning is a medical emergency that requires urgent therapeutic procedures. The treatment of venomous snakebites is still controversial because of unclear therapeutic modalities. Choice of treatment is dictated in part by regional characteristics with regard to patient population and types of venomous snakes. The purpose of the study presented here was to report regional experience with venomous snakebites and to describe first-aid, pre-hospital, and hospital therapeutic procedures for horned viper bite. During a 16-year period, from 1980 to 1996, at the Clinical Hospital Split (Croatia) we collected data on 389 victims of horned viper bite. Incidence of the local and general complications is presented. We also reviewed therapeutic modalities and outcome with special attention to compartment syndromes and the indications for fasciotomy.

Adult↗
PubMed1996

Differences in origin and fate between the cranial and caudal spinal cord during normal and disturbed human development.

Differences in histological appearance between the cranial and caudal parts of the spinal cord and associated axial organs were analyzed in 9- and 15-week-old human dysraphic fetuses and compared with normal fetuses. In human development the cranial part of the neural tube down to the lumbosacral level forms during primary neurulation, while its caudal part results from secondary neurulation. In the 9-week fetus with cervical spina bifida, the cranial spinal cord displayed a variety of morphological changes along the cranio-caudal axis. Spinal cord in the upper cervical region transformed into the area cerebrovasculosa, while the lower cervical and thoracic levels showed only disturbed differentiation of the cell layers and roof plate. The degree of the cranial spinal cord dysmorphogenesis correlated with anomalies of the underlying notochord and vertebral column. The caudal to lumbosacral region of the spinal cord appeared normal. In the case of the 15-week-old fetus with complete dysraphia, the area cerebrovasculosa was found along the whole extent of the cranial spinal cord, while more caudally, all axial organs showed a normal histological structure. Our findings confirmed a different origin for the cranial and caudal parts of the human spinal cord. The appearance of dysraphic disorders corresponded to the time of primary neurulation; therefore, they resulted in the faulty formation of the cranial spinal cord. Normally formed caudal spinal cord appears during secondary neurulation at later developmental stages.

Age Factors↗
PubMed1996

Effect of maternal hyperoxygenation on experimentally produced uteroplacental insufficiency in the rat.

The paper examines the effects of maternal hyperoxygenation on uteroplacental insufficiency produced by ligation of the uterine artery. Maternal hyperoxygenation did not significantly affect experimentally produced growth retardation or survival of the fetuses from the ligated horn. Analysis of the vascular anatomy revealed that additional oxygen improves the survival of fetuses compromised by uteroplacental insufficiency only in the presence of anastomosis between the uterine and ovarian arteries. The study demonstrated the importance of that anastomosis in evaluating the results obtained by this experimental model.

Animals↗
PubMed1995

War injuries of the crural arteries.

Twenty-eight patients with military crural vascular injuries are presented. In the group undergoing immediate repair (21 patients), the time interval between trauma and surgery was 20 min to 30 h (mean 8 h 30 min). In those receiving delayed repair (seven patients), the interval between trauma and surgery was 3-47 (mean 14) days. Hyperbaric oxygenation therapy was used in conjunction with surgery and antibiotic therapy in 13 of the 28 patients. Explosive injuries were found in 14 patients and high-velocity missile injuries in nine; associated fractures were present in 20. Twenty of the 28 patients with crural vascular injuries had combined arterial and venous injuries, while eight had isolated arterial injuries. Twenty-five patients with distal ischaemia required arterial repair; five late amputations resulted. Military crural vascular injuries should be treated with soft tissue debridement, removal of foreign material, and microvascular arterial and concomitant vein reconstruction. This should be followed by external skeletal stabilization for bony and/or soft tissue instability, with fasciotomy for any associated compartment syndrome. The wound should be left open, with delayed closure or split skin grafting. It was felt that hyperbaric oxygen therapy reduced the amputation rate following combat-related crural vessel injuries.

Adolescent↗
PubMed1995

Variations in the formation of the human caudal spinal cord.

Collection of 15 human embryos between 4-8 developmental weeks was used to histologically investigate variations in the development of the caudal part of the spinal cord and the neighboring axial organs (notochord and vertebral column). In the 4-week embryo, two types of neurulation were parallelly observed along the anteroposterior body axis: primary in the areas cranial to the neuroporus caudalis and secondary in the more caudal tail regions. In the 5-week embryos, both parts of the neural tube fused, forming only one continuous lumen in the developing spinal cord. In the three examined embryos we found anomalous pattern of spinal cord formation. Caudal parts of these spinal cords displayed division of their central canal into two or three separate lumina, each surrounded by neuroepithelial layer. In the caudal area of the spinal cord, derived by secondary neurulation, formation of separate lumina was neither connected to any anomalous notochord or vertebral column formation, nor the appearance of any major axial disturbances. We suggest that development of the caudal part of the spinal cord differs from its cranial region not only in the type of neurulation, but also in the destiny of its derivatives and possible modes of abnormality formation.

Abortion, Legal↗
PubMed1995

Surgical experience at the Rama war hospital in Bosnia and Herzegovina.

We present our experience in the treatment of 1,300 wounded at the Rama war hospital in Bosnia and Herzegovina. Rama surgical teams performed mainly chest, abdominal and vascular operations, and other operations if the patient's life was considered to be in danger. All severely wounded patients were transported in a stable hemodynamic state to the Split University Hospital within 48 to 72 h, as the Rama hospital was primarily an evacuation facility. Owing to the well-organized first aid provided and the rapid evacuation from the combat line, all patients were operated within 3 h after injury. This, together with the excellent functioning of our blood bank were factors responsible for our good results. Among the 226 casualties operated under general anesthesia, mortality was 8.4% (19 cases). The most common causes of death were multiple injury and irreversible hemorrhagic shock.

Adolescent↗
PubMed1994

Survival analysis of untreated patients with non-small-cell lung cancer.

The survival rate analysis of 130 patients with non-small-cell lung cancer who did not receive any specific anticancer therapy showed no statistically significant differences in the survival rates between various TNM combinations classified into stage groups II, IIIa, IIIb, and IV, as proposed by Mountain in 1989 and adopted by the American Joint Committee on Cancer. Following these findings, based on survival probabilities, two distinctive staging groups could be distinguished. The first stage group was composed of only the T1, 2N0, M0 combination, and the second of all other TNM combinations. In a purely biologic sense of tumor growth, the lymph node involvement appeared to be the crucial factor determining the length of survival.

Adult↗
PubMed1993

Histological features of axial structures during embryonic and fetal stages of human craniorachischisis.

Histological characteristics of developing axial structures in human conceptuses with craniorachischisis were investigated during the embryonic and fetal periods and compared with normal samples. The morphological relationship of the notochord to the axial skeleton and neural tube was analyzed along cervical and thoracic vertebral segments using serial paraffin sections. The embryonic stage of malformed conceptuses disclosed a correlated affection of the notochord and vertebral column, as well as the overlying central nervous system. The degree of histological changes within the spinal cord depended on the level of the vertebral axis examined: completely unorganized nervous tissue was overlying cervical and upper thoracic vertebrae, while more caudally it resembled a normal spinal cord. During the fetal period the histological disturbances of all axial structures were more pronounced. Extensive notochordal branching was associated with the malformed formation and ossification of the vertebral column. At this stage we found no correlation of histological changes between the spinal cord and the mesodermally derived structures (notochord, vertebral column) along the cranio-caudal body extent, as neural tissue had completely transformed into area cerebrovasculosa. We speculate that our histological observations could be the result of primary affection of mesodermal structures during very early stages of development. Divergence in histological findings within axial structures between the embryonic and fetal periods support recent mutational investigations on animals.

Brain↗
PubMed1993

Effects of hyperbaric oxygen on rat embryos.

The aim of the study was to investigate the toxic effects of hyperbaric oxygen (HBO) on rat embryos. Two groups of Fischer pregnant rats were exposed to oxygen at pressures of 324 and 426 kPa for 90 min per day for 5 consecutive days (8-12 days of gestation). The third group was exposed to normobaric oxygen for 12 h on the eighth day of gestation. Two control groups were used; the first was comprised of intact and the second of sham-treated animals. The HBO treatment did not significantly affect maternal weight gain or reduce litter size, nor did it induce any embryonic abnormalities. However, the fetal body weight was reduced and the placental weight increased in the groups exposed to HBO at pressures of 324 and 426 kPa. When female fetuses which had been exposed to oxygen at 324 or 426 kPa were compared to the intact control group, a reduction in wet weights of 9.2 (p < 0.05) and 12.1% (p < 0.01), respectively, was noted. Male fetuses exposed to oxygen at 324 and 426 kPa displayed a reduced body weight of 11.7 (p < 0.01) and 16.6% (p < 0.01), respectively. Placental weight was increased by 18.9 (p < 0.01) and 23.6% (p < 0.01) in the groups exposed to oxygen at 324 and 426 kPa, respectively. These data suggest that HBO, either at 324 or 426 kPa, is not potent at inducing malformations and that the largest embryotoxic effects are upon fetal body weight and placental weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

[Blunt heart injuries and diagnostic difficulties].

The authors present their experiences with blunt heart injuries treated in the University Surgical Hospital in Split, Croatia. The diagnostic approach hospitalization and follow-up of these patients are described. The heart contusion was diagnosed using several repeated electrocardiographic and enzymatic tests combined with two-dimensional echocardiography. We treated 67 patients with heart contusions within two-year period. Out of them, 63 (94%) were dismissed from the hospital as cured, and 4 (6%) of them died. Results of treatment depend on the severity of injury, but also on a timely and adequate management.

Adult↗
PubMedDate not supplied

[Reasons for founding a University of Split Medical School].

This article advocates a transformation of the Zagreb University School of Medicine Split Branch into an independent medical school, i.e. Split University School of Medicine. The difficulties stemming from the present organizational scheme of work of Medical School in Zagreb and its Split Branch, and particularly from the complex political and geographical relations, are a heavy burden thwarting the work of both institutions. On the other hand, the medicine in Split has all indicators which should guarantee a successful work of an independent medical school in the city. These indicators concern capacities of the local premises, number and quality of the faculty, long tradition of medical education, and recent educational, medical and scientific results. A particularly important argument is an immense need of southern Croatia and the neighbouring parts of Bosnia and Herzegovina for medical education. A careful analysis showed that the independent Medical School would neither impose additional expenses from the part of the Republic, nor cause an overproduction of physicians. A state examination organized so that the results of the candidates could be quantified, would provide an unequivocal answer to the question on the number of medical schools needed in Croatia and, more important, the picture of the quality of their work.

Croatia↗
PubMedDate not supplied

[The Internet in medicine].

Internet is a global computer network that connects numerous smaller computer networks. During the last several years Internet has become enormously popular and the number of users in the world has increased to 30 million. Internet is now a major tool for sharing computers resources and for communication between individuals and scientific institutions. Internet also contains enormous quantities of medical information and knowledge. During the last several years, many new sites have emerged on the Internet, offering exciting and useful information on medical practice, research, decision support, and education. This article describes the history of the Internet, the various ways of connecting to it and some of the tolls particularly useful for medical doctors. This article provides a tutorial how to access the important medical resources that Internet offers to the clinicians, teachers, and researcher. Also this article will provide description of access, structure and contents of the two World Wide Web locations. BioMedNet is a location designed for biomedical research. It was chosen because of its exceptional quality and importance for researchers. The second described location is CHORUS, developed for continuing education in radiology.

Computer Communication Networks↗