Thoraxtrauma

Chest injuries can be sustained in isolation or in association with multiple injuries. Life-threatening complications may ensue because organs that are vital to survival of the organism are situated within the thoracic cavity. These complications include airway obstruction, tension pneumothorax, wide open pneumothorax, flail chest, cardiac tamponade and massive hemothorax. The mortality of patients hospitalized with chest injury can be as high as 10%. Clinical examination and awareness of the possibility of other injuries (high level of suspicion) are essential, and standard chest X-ray, ultrasound and thoracic computed tomography may also be needed for the diagnosis. The first part of this serial paper on the management of chest injuries focuses on anatomical aspects, pathophysiology and symptoms, but mainly on the indications for the standard diagnostic procedures and further high-tech examinations.     

How to integrate a lactation consultant in an outpatient clinic environment.

Successful efforts in improving breastfeeding initiation rates at an urban teaching hospital prompted the hospital to create a lactation consultant (LC) position in the outpatient setting to focus on breastfeeding duration. This article reviews the complexity of the clinic setting, with the challenges and benefits of the consultant's first year in one of the hospital's outpatient clinics. Preliminary data collected by the consultant suggest that patients counseled by the LC in the outpatient clinic setting have longer breastfeeding duration rates.     

Hood versus mask nebulization in infants with evolving bronchopulmonary dysplasia in the neonatal intensive care unit.

OBJECTIVE: To compare infants' discomfort, nursing-time and caregiver preference, and assess the clinical efficiency (as a secondary outcome) of hood versus facemask nebulization in infants with evolving bronchopulmonary dysplasia (BPD) in the neonatal intensive care unit. STUDY DESIGN: A prospective, open, randomized, controlled crossover clinical trial. In total, 10 infants with BPD who were on inhaled beta-agonist bronchodilators and corticosteroids were randomly assigned to receive their nebulized treatments either by a facemask, or by a hood for 2-3 days, and then crossover to receive the same treatments with the other technique for another 2-3 days. Infants' discomfort, nursing-time, caregiver preference and clinical efficiency were compared. RESULTS: At baseline there was no significant clinical difference between the groups. Nurse-time required for administering the hood nebulization (mean+/-s.e.m.: 1.9+/-0.1 min) was significantly shorter than the time for mask nebulization (12.0+/-0.6 min, P<0.0001). Infants' discomfort score was significantly lower (0.1+/-0.04) for hood versus mask nebulization (2.5+/-0.2, P<0.0001). Nurses and parents unequivocally preferred the hood treatment. During both mask and hood nebulization therapies (2-3 days) clinical efficiency was comparable. While both methods caused an immediate (20 min post) clinical improvement, the immediate respiratory assessment change score was significantly greater for the hood versus the mask nebulization (0.62+/-0.27 versus 0.13+/-0.14, P<0.05). CONCLUSIONS: Nebulization of aerosolized medications in infants with evolving BPD by hood was less time-consuming for caregivers and was much better tolerated by the infants while being at least as effective as the conventional facemask nebulization.     

Evaluation of an enzyme immunoassay kit for estrogen receptor measurement--report II

We present evidence to show that monoclonal antibodies to estrogen receptors (ER) in solid phase recognize the secondary estrogen binding sites with moderate to low affinity for estradiol (E2). An excellent quantitative agreement was found in five cytosols between the ER values obtained by the enzyme immunoassay (ER-EIA) and the amount of secondary estrogen binding sites measured by the assay involving dextran-coated charcoal (Clin Chem 1986;32:1496). The immunoreactive protein recognized by the antibody-coated beads, when allowed to react with ER(+) cytosols, is shown to bind [3H]estradiol only when the ligand concentration exceeds 8 nmol/L. Further biochemical and functional characterization of the immunoreactive protein is required to establish similarities/dissimilarities between this protein, high-affinity Type I ER sites, and the secondary sites such as Type II sites.     

Die klassifikatorische und pr?diktive Qualit?t des Merkmals “suicide intent” bei Parasuiziden Eine clusteranalytische Untersuchung Eine clusteranalytische Untersuchung

In einer clusteranalytischen Untersuchung mit 137 Patienten, die einen Parasuizid verübt hatten, wurden 6 Subgruppen unter Berücksichtigung der Klassifikationsvariable “suicide intent” isoliert. Es wurde die Hypothese geprüft, dass sich sowohl die Motivstrukturen als auch die Raten an wiederholten Parasuiziden in Abh?ngigkeit der Clusterl?sung bedeutsam voneinander unterscheiden. Die Ergebnisse unterstützen die Annahme einer zunehmenden Ausdifferenzierung der interpersonell orientierten Motivstrukturen mit sinkendem bzw. einer Einengung der Motivstruktur auf den Todeswunsch mit steigendem “suicide intent”. Es wurden folgende Subgruppen differenziert: eine Suizid-Hochrisikogruppe mit ausschlie?licher Todesintention und -motivation, 2 moderate Suizid-Risikogruppen mit hoher Todesintention und leichten Tendenzen zu interpersoneller Motivation, eine Subgruppe, gekennzeichnet durch eine manipulativ/strategisch orientierte Motivstruktur und auff?llig h?ufigen Parasuizidwiederholungen, eine Subgruppe mit vorrangig appellativ orientierten Motiven, Kontrollverlust und vergleichsweise seltenen Parasuizidwiederholungen und eine Subgruppe mit ambivalenter Motivstruktur (interpersonell und todesorientiert).