Farm-related trauma in the west of Ireland: an occupational hazard

Background

Farm fatalities in Ireland remain at their highest recorded levels despite the introduction and implementation of several farm safety initiatives during recent years.

Aims

The aim of this study was to examine all farm-related morbidity and mortality presenting to a general hospital in the west of Ireland.

Methods

A consecutive series of all farm-related fatal and non-fatal injuries presenting to our institution over a 7-year period (2005–2011) was compiled by examining the hospital inpatient enquiry system and mortuary records.

Results

One hundred and thirty patients were admitted to Mayo General Hospital with non-fatal farm-related injuries during the study period. This cohort was comprised 104 males and 26 females with an average age at presentation of 46 (range 19–75) years. The most common mechanism of non-fatal injury was animal attack. The mean length of hospital stay, mean length of ICU stay and total number of bed days used were 5.2, 5.3 and 677 days, respectively. There were seven farm-related fatalities during the same study period. Four were livestock-related, two due to machinery accident and one due to fall of a heavy object. The post-mortem findings were analysed in each case.

Conclusions

This analysis outlines the incidence and severity of fatal and non-fatal injuries sustained in the farming workplace and presenting to a general hospital serving a rural catchment population. Greater awareness of our results may help reduce the longterm incidence and magnitude of such injuries.     

New frontiers in the treatment of the trauma victim with facial injuries

Use of rigid fixation in facial skeletal reconstruction has had a resurgence in popularity. Miniplates and screws to rigidly fix fractures, control occlusal osteotomies, and even congenital craniofacial osteotomies, have revolutionized facial reconstructive surgery. In facial fractures, where restoration of preinjury facial appearance is the goal, rigid fixation has added a new treatment potential, providing immediate three-dimensional stability of the fracture reduction.     

Application of revised trauma evaluation program in emergency treatment of multiple injuries

Recently, with the rapid development of highway ,and high-rise buildings, trauma shows a tendency to increase continuously. The proportion of trauma patients with multiple injuries has increased and trauma arising from multiple injuries has become ＂the first public hazard＂.     

合并闭合性腹内脏器损伤的多发性创伤的诊断及治疗

目的　探讨合并闭合性腹内脏器伤的多发性创伤的临床特点及诊治。　方法　 15 9例合并闭合性腹内脏器伤的多发性创伤 ,损伤严重性计分指数 (ISS) >17分 ,对患者的诊治情况进行回顾性分析。　结果　 15 9例中有 3个或以上部位损伤的 6 0例 ,占 37.7%。诊断性腹腔内穿刺、B超及CT阳性率分别为92 .2 %、92 .6 %和 93.3%。死亡 18例 ,死亡病例平均ISS评分 34.1± 11.6分 ,非死亡病例为 2 1.6± 4 .8分 ,差异有非常显著意义 (t=8.4 8,P <0 .0 1)。　结论　应重视对多发创伤患者腹内脏器损伤的术前诊断及动态观察 ,以防腹内脏器损伤漏诊     

Alcohol, cannabis and cocaine usage in patients with trauma injuries

Sera from 111 patients with trauma injuries, who presented to the Accident and Emergency Unit (A&E), University Hospital of the West Indies, during a 3-month period, were screened for blood alcohol. Urine specimens were analysed for metabolites of cannabis and cocaine. Sixty-two per cent (62%) of patients were positive for at least one substance and 20% for two or more. Positivity rates were as follows: cannabis (46%), alcohol (32%) with 71% of these having blood alcohol levels (BAC) greater than 80 mg per decilitre; cocaine (6%). Substance usage was most prevalent in the third decade of life. The patients who yielded a positive result were significantly younger than those who were negative. There was no significant difference in age or substance usage between the victims of interpersonal violence or road traffic accidents. In the group designated "other accidents", patients were significantly older and had a lower incidence of substance usage than the other two groups. Cannabis was the most prevalent substance in all groups. Fifty per cent (50%) and fifty-five per cent (55%) of victims of road accidents and interpersonal violence, respectively, were positive for cannabis compared with 43% and 27% for alcohol, respectively. There was no significant difference in Hospital Stay or Injury Severity Score between substance users and non-users.     

集束化护理管理在负压引流术治疗骨科创伤感染患者中的应用研究

目的 探讨集束化护理管理在负压引流术治疗骨科创伤感染患者中的应用效果,为临床护理提供新的依据和方法.方法 选择2019年7月—2020年7月于中国人民武装警察部队海警总队医院骨科住院治疗的创伤感染患者150例,按照便利抽样法将其分为干预组和对照组,每组75例.对照组患者给予常规护理,干预组在对照组的基础上实施预防骨科创...     

Familial breast cancer genetic testing in the West of Ireland

Aims

The majority of hereditary breast and ovarian cancers are associated with highly penetrant mutations in two genes: BRCA 1 and 2. Our aim was to investigate the prevalence and types of BRCA mutations in patients from the West of Ireland.

Methods

A retrospective cohort study was undertaken that included all patients from the counties, Mayo, Sligo, Galway, Roscommon, and Clare, who were referred to the National Centre for Medical Genetics (NCMG) for testing for mutations in BRCA 1 or 2 between 2000 and 2010. Data including age, symptoms, family history, Manchester score, and test results were recorded and analysed using SPSS.

Results

The NCMG received 380 referrals from the Western seaboard, including 148 for diagnostic testing and 232 for predictive evaluation. Sixty-five patients did not attend for assessment. Two hundred and fifty-six patients fulfilled criteria for genetic counselling, which was accepted by 184, of whom 127 proceeded to testing. Predictive tests were more often declined than diagnostic [41 (46 %) vs. 16 (17 %)]. Ten mutations in BRCA 1 were identified in 20 patients (15 families), including Exon 1–23del (3 families); Exon 14–20del (2 families) and E143X (2 families). Six mutations in BRCA 2 were identified in 15 patients (12 families) including 8525delC (n = 2 families) and 8205-1G>C (n = 3 families). Patients with positive results had significantly higher Manchester scores than those with negative tests [median 25.5 (12–48) vs. 20 (8–37), p = 0.042, Mann–Whitney U test].

Conclusion

To identify patients with highly penetrant variants, referrals should be made with strict adherence to guidelines. Counselling should be individualised to counteract intrinsic psychological barriers to testing.     

干细胞外泌体在骨科创伤中的修复机制及研究进展

创伤是骨科常见的受伤机制,伤口、软组织及骨组织愈合慢、延迟愈合甚至不愈合给患者及家属带来巨大的心理和经济负担,也为临床医生的工作添加了难度。创面和软组织愈合不良,不仅对患者的外观造成影响,而且对患者的功能和生活质量造成直接影响,创伤后骨组织愈合延迟和不愈合的风险也会大大增加,甚至坏死的几率也会大大增加。故而在既往治疗骨科创伤的基础之上,早期干预、促进修复会取得更好的治疗效果。外泌体(exosomes,exos)是间充质干细胞(MSC)分泌的多泡体(mesenchymalstemcell,MSC),是一种可作为细胞间媒介参与细胞通信、细胞迁移、细胞免疫和肿瘤细胞生长等过程的载体,含有多种调控细胞代谢因子。近年来,随着干细胞外泌体研究的逐步深入,人们发现MSC-EXOS可以作为一种非细胞手段参与组织修复,而MSC-EXOS强大的非细胞治疗潜能为治疗创伤修复提供了新的研究方向。现就MSC-exos对于创伤修复的作用机制进行综述。     

Health care and illness in Lihir, New Ireland Province, in the context of the development of the Lihir gold mine

During 2000 a review of health care and illness in Lihir, New Ireland Province, was carried out while I was employed as a Community Health Research Officer with the Lihir Management Company, the manager of a gold mine on Lihir. The review aim was to document the health care providers for the local population and the illness burden suffered by Lihirians, and then to shape services to have a more preventive emphasis. It was discovered that the health care services available were well utilized by Lihirians. Health care was provided by the church, government and the mining company, and needed better coordination of services. Lihirians faced a relatively heavy burden of illness, with malaria the most common affliction. They also suffered significantly from lymphatic filariasis and tuberculosis, and children were poorly nourished. A considerable number of recommendations have been adopted since the health review to improve the health of, and delivery of health services to Lihirians.     

Major trauma in West Virginia dementia patients injury patterns, discharge dispositions and implications for treatment and injury prevention

Our study examines injury patterns, treatment implications, discharge disposition, and injury prevention for trauma patients with dementia. It is a retrospective observational study of trauma patients at the Jon Michael Moore Trauma Center at West Virginia University Hospitals. Causes of injury, injuries sustained, and discharge disposition were examined in 286 trauma patients with a pre-existing diagnosis of dementia and 5,865 trauma patients without dementia. All patients included in this study were 40 years of age or older. Injury data were compiled for patients with dementia. Causes of injury and discharge disposition were compared for the two groups.     

A review of the nature and activity of a general surgical service in Ireland

The steady increase in hospital costs has led to demands for closer scrutiny of activity levels, workloads and outcomes. This study sought to examine these parameters in a typical district general surgical unit in this country. In the five year period 1985-89,11,227 inpatient and 3,354 outpatient procedures were performed; 83% of the inpatient procedures were elective and 17% were emergency surgical operations. All inpatient procedures were categorized: minor (41%), intermediate (42%) and major (17%). A prospective one year review in 1990/1991 confirmed the accuracy of the retrospective data. During that year 2,335 inpatient operations and 765 outpatient operations were performed, of which 80.5% of the inpatient operations were elective and 19.5% were emergency procedures. Of these 16.6% were major, 34.4% intermediate and 49% were minor operations. 60% of the operations were performed by consultants. The in-hospital surgical mortality for the 1 year prospective review was 1.35% and the perioperative mortality was 0.64%. The overall operation morbidity rate was 9% and the procedure-related morbidity was 4.7%. The wound infection rate was 2%. Of the common operations performed throughout the six year study period appendicectomies and external hernia operations accounted for 20% of the caseload; 14% were urological, 7% were breast and 6% were biliary operations. The average waiting time for elective admissions was less than 4 weeks. The average length of hospital stay and the bed occupancy rates did not change.     

乌司他丁治疗多发伤合并重症颅脑损伤效果的系统评价简

目的 评价乌司他丁治疗多发伤合并重症颅脑损伤的效果.方法 通过检索2003年1月1日～2013年1月1日PubMed、Science Direct、EBSCO Host、EMbase、The Cochrane Library、中国学术期刊全文数据库、万方数据库、维普中文科技期刊全文数据库,对纳入研究的方法学进行评价.研究者对纳入文献的质量进行严格评价和资料提取,使用Review Manager 5.0软件对符合质量标准的随机分组对照临床试验（RCT）行系统评价.结果 7个RCTs共纳入306例患者,其中治疗组（使用乌司他丁）159例,对照组（使用常规治疗）147例,系统评价结果显示：治疗72 h后,相比于对照组,治疗组患者的颅内压并未产生显著变化（P＞0.05）,但肿瘤坏死因子-α含量显著下降,白介素-6含量显著下降,C反应蛋白含量显著下降（P＜0.05）.结论 乌司他丁能显著抑制炎症介质的释放,减轻机体对创伤侵袭的反应,在治疗多发伤合并重症颅脑损伤中表现出显著优越性,值得临床推广.