Outcomes of traumatic hemorrhagic shock and the epidemiology of preventable death from injury

The majority of potentially preventable deaths after trauma are related to hemorrhage and occur early after injury, with the largest number of deaths occurring before hospital arrival. Approximately one‐fourth of trauma deaths may be potentially preventable through early medical and surgical interventions. Interventions dedicated to bleeding control and hemostatic resuscitation have demonstrated merit in decreasing hemorrhagic injury mortality. Advancing these novel strategies to the casualty in the prehospital phase of care, particularly in tactical or austere environments, may prove beneficial for hemorrhage mitigation to temporize the window of survival to definitive care. Future studies of resuscitation and survival after traumatic injury must include analysis of prehospital deaths to fully understand the outcomes of early interventions.     

Genetic markers may predict disease behavior in patients with ulcerative colitis

BACKGROUND & AIMS: Recent studies have suggested that HLA DRB1*0103 and allele 2 of the interleukin 1 receptor antagonist (IL-1RA) gene predict severe and extensive ulcerative colitis, respectively. The aim of this study was to test these hypotheses in patients undergoing surgery for their colitis. METHODS: HLA DRB1 and DQB1 genotyping was performed in 99 patients and 472 controls. Genotyping for polymorphisms of genes encoding tumor necrosis factor alpha and IL-1RA was performed in 107 patients and 89 controls. Measurement of antineutrophil cytoplasmic antibody (ANCA) was performed in 72 patients and 58 healthy subjects by fixed neutrophil enzyme-linked immunosorbent assay and indirect immunofluorescence. RESULTS: The DRB1*0103 allele was increased in patients (14.1% vs. 3.2% in controls; P < 1 x 10[-5]). This association was greatest in patients with extensive disease (15.8%; P < 0.0001) or extraintestinal manifestations (22.8%; P < 0.0001): mouth ulcers (25.8%; P < 0.0001), arthritis (27.2%; P < 0.0001), and uveitis (35.7%; P < 0.0001). The DRB1*04 alleles were reduced in patients (P = 0.005). Differences were noted between extensive and distal disease in the frequency of allele 2 of IL-1RA (10.9% in distal vs. 28.6% in extensive; P = 0.01) and allele 2 homozygosity. ANCA was detected in 76.4% of patients. Carriage of IL-1RA allele 2 and tumor necrosis factor 2 allele was increased in ANCA-positive patients. CONCLUSIONS: Genetic markers may predict disease behavior in ulcerative colitis. (Gastroenterology 1997 Jun;112(6):1845-53)     

A novel treatment for chronic pancreatitis

Background Hereditary pancreatitis is an important cause of chronic pancreatitis, which may result in endocrine and exocrine failure. This may necessitate simultaneous pancreas and kidney transplant (SPK). Bladder drainage of the exocrine secretions may cause problems. Aim To report one such case and its surgical correction. Methods A 20-year-old male with insulin-dependent diabetes mellitus secondary to idiopathic chronic pancreatitis had a SPK with bladder drainage. Urological and metabolic complications secondary to the drainage of pancreatic secretions, rich in proteolytic enzymes required convertion from bladder to enteric drainage. Results He was able to discontinue his pancreatic enzyme supplements, ceased to have steatorrhoea and gained weight. He was referred to the €pean Registry of Hereditary Pancreatitis and Familial Pancreatic Cancer (€PAC), hereditary pancreatitis was confirmed by genetic analysis. Conclusion Enteric-drained pancreas transplantation is a successful treatment for exocrine as well as endocrine pancreatic failure and should be considered as a treatment option in patients with chronic pancreatitis.     

Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases

Between 1963 and 1980, one or more posterior-lateral foraminotomies were performed for simple cervical radiculopathy as the sole operative procedure for 736 patients. One hundred three patients (14%) required a second posterior procedure, but only 24 (3%) cases represented true recurrent radiculopathy. There were 13 minor complications (1.5%) and no deaths or detectable incidence of air embolism. All operations were done with the patient in the sitting position. Central venous pressure monitoring was used only infrequently. There was a 96% incidence of relief of significant arm pain and/or paresthesia and a 98% incidence of resolution of preoperatively present motor deficit. Eight hundred twenty-eight procedures (98%) were preceded by Pantopaque cervical myelography. There was a 71.5% incidence of correlation between preoperative clinical findings (both sensory and motor) and operative findings. In 13% of the cases, two spaces were thought by the operating surgeon to be equally involved by the spondylotic process. Most (91.5%) of the patients describe themselves as either "good or excellent" postoperatively. There was no significant difference postoperatively regarding results or recurrence between patients with suspected soft or hard disc protrusions and those with strictly spondylotic radiculopathy. Nor was there any statistical difference in results among the three patient population groups ("private" vs. compensation vs. liability). The mean length of time to return to work or other "normal" activities was 9.4 weeks. The mean length of follow-up time was 146 weeks (2.8 years). There was an associated incidence of significant lumbar disc and/or foraminal disease requiring operation of 33.4%.     

Flax seed oil and flax seed meal reduce the formation of aberrant crypt foci (ACF) in azoxymethane-induced colon cancer in Fisher 344 male rats.

Flax seed oil and flax seed meal are good sources of omega-3 fatty acids. The objective of this study was to explicate the effects of feeding flax seed oil and flax seed meal on AOM-induced aberrant crypt foci (ACF) in Fisher 344 male rats. Following an acclimatization period, rats were divided into six groups and fed AIN 93G diet Control (C), C+7 and 14% soybean oil (SBO), C+7 and 14% flax seed oil (FSO) and C+10 and 20% flax seed meal (FSM). All rats received 16 mg/kg body weight of AOM at 7 and 8 weeks of age. The rats were euthanized with CO2 at 17 weeks of age. FSM and FSO reduced the incidence of ACF which are putative precursor lesions in the development of colon cancer in the distal colon by 88% and 77%, in the proximal colon by 86% and 87% with a total reduction of 87.5% and 84%, respectively. Glutathione-S-transferase (GST) activities were significantly (P<0.05) higher in rats fed C+7 and 14% FSO and C+10 and 20% FSM, as compared to rats fed C+SBO diets. Results of this study showed that FSO and FSM reduced the incidence of AOM-induced ACF formation and may therefore be effective chemopreventive agents.     

Effects of positive and negative pressure ventilation on cerebral blood volume of newborn infants

The effects of intermittent positive airway and continuous negative extrathoracic pressure ventilation on cerebral blood volume in preterm infants were studied using near infrared spectroscopy. In 12 infants continuous negative extrathoracic pressure caused a median decrease in cerebral blood volume of 0.14ml/100ml brain (95% confidence intervals (CI) 0.035–0.280) compared with no respiratory support. Oxygenated and deoxygenated haemoglobin also decreased, implying increased venous drainage as the main effect. In 17 infants intermittent positive pressure ventilation also caused a median reduction in cerebral blood volume of 0.06 ml/100 ml brain (95% CI 0.010–0.115) compared with endotracheal positive airway pressure. Deoxygenated haemoglobin increased by 0.07 ml/100 ml brain (95% CI 0.010–0.100) while oxygenated haemoglobin decreased by O.lOml/lOOml brain (95% CI 0.005–0.175). The increase in deoxygenated haemoglobin implies decreased venous drainage and the decrease in oxygenated haemoglobin implies that other factors may also be significant. Heart rate, blood pressure and oxygen saturation were monitored continuously and remained stable.     

Relation of age, race, and allotype to immunoglobulin subclass concentrations

Concentrations of IgG1, IgG2, and total IgG were measured by a solid phase radioimmunoassay in sera from 36 healthy adults and 114 healthy children. As expected, IgG2 and total IgG had a positive correlation with age in children. In addition to age, several other factors were associated with significant differences in serum subclass concentrations. Female children had higher concentrations of IgG1 than males, and black subjects had significantly higher concentrations of IgG1, IgG2, and total IgG than whites. Although Km(1) and Gm(23) immunoglobulin allotypes had no relation to subclass concentrations when tested as single factors, the Km(1) allotype interacted significantly with race so that Km(1)-positive black children had higher IgG2 concentrations than other subjects. Our findings may explain, in part, recent observations of an association of the Km(1) allotype with altered immune responses of blacks to certain vaccines containing bacterial polysaccharides. In addition, our data indicate the need to control factors such as sex, race, and allotype in studies of subclass concentrations or immune responses.     

IgG subclass response to immunization with Haemophilus influenzae type b polysaccharide-outer membrane protein conjugate vaccine

We immunized 117 children with either Haemophilus influenzae type b polysaccharide vaccine or type b polysaccharide coupled to an outer membrane protein of group B Neisseria meningitidis (conjugate vaccine), and measured the IgG, IgG1, and IgG2 subclass composition of antibody to type b polysaccharide in postimmunization sera by ELISA. The IgG responses of 51 children, 24-83 months of age, immunized for the first time with the conventional type b vaccine consisted of both IgG1 and IgG2 antibody (respective geometric means of 2.24 and 0.77 micrograms/ml). In contrast, the IgG responses of 28 infants, 2-17 months of age, immunized with conjugate vaccine were predominantly or exclusively IgG1 (genometric mean IgG1 and IgG2 antibody concentrations of 1.92 and 0.19 micrograms/ml). A total of 38 children was primed with conjugate vaccine between 2 and 17 months of age and boosted approximately 1 yr later. The 28 children boosted with type b polysaccharide vaccine showed memory antibody responses consisting of both IgG1 and IgG2 (respective geometric means of 12.7 and 4.8 micrograms/ml); the 10 children boosted with conjugate vaccine showed a similar pattern of IgG subclass responses (respective geometric means of 20.8 and 5.1 micrograms/ml, p greater than 0.4 compared to the respective geometric mean IgG1 and IgG2 values of the group boosted with polysaccharide). Thus, in children 24-83 months of age, immunization with conventional type b polysaccharide vaccine generally elicits both IgG1 and IgG2 responses, with a slight predominance of IgG1.(ABSTRACT TRUNCATED AT 250 WORDS)