“Is this a dagger I see before me?” — an audit of stabbings and gunshot wounds in Limerick

Background According to a recent study in Cardiff, the incidence of stab wounds is 14 per 100,000 population per annum. No such figures are available for Ireland. Aim To evaluate the incidence, type of injury, medical consequences and outcome of patients with stab or gunshot wounds presenting to the Mid-Western Regional Hospital, Limerick, over a 12 month period. Method A retrospective case study of all stab and gunshot wounds presenting over a 12 month period. Results Out of 62,000 new presentations to the Accident and Emergency (A&E) department, 101 (0.16%) were stabbings, giving an incidence of 33 per 100,000 population. Twenty-six patients required surgical intervention. There were three deaths. There were 10 gunshot wounds, of which 40% required surgical intervention, with no mortalities. Conclusion The incidence of stab wounds presenting to our institution is high. Although constituting a small percentage of presentations to the A&E department they result in considerable morbidity and surgical activity.     

多层螺旋CT血管造影诊断主动脉弓离断1例

主动脉弓离断（interrupted aortic arch，IAA）是一种少见的先天性心血管畸形，常并发多系统的畸形，在新生儿中发生率约为1／10000，在先天性心脏病患儿中约占1％。我们应用多层螺旋CT（multi—slice computed tomography，MSCT）血管造影诊断IAA 1例，并经手术证实，现报道如下。     

Eclampsia despite strict dietary sodium restriction

The classic indication for prescribing dietary sodium restriction in pregnancy has been the prevention of eclampsia. We describe a case of intrapartum eclampsia in a 24-year-old nulliparous woman. A strongly sodium restricted diet was prescribed because of pre-eclampsia. Compliance to the diet was checked with 24-hour urinary sodium excretion. This report, describing the first case of eclampsia despite neglectable urinary sodium excretion, adds to the view that sodium restriction in pregnancy is obsolete.     

Determinants of patient recruitment in a multicenter clinical trials group: trends,seasonality and the effect of large studies

Background

We examined whether quarterly patient enrollment in a large multicenter clinical trials group could be modeled in terms of predictors including time parameters (such as long-term trends and seasonality), the effect of large trials and the number of new studies launched each quarter. We used the database of all clinical studies launched by the AIDS Clinical Trials Group (ACTG) between October 1986 and November 1999. Analyses were performed in two datasets: one included all studies and substudies (n = 475, total enrollment 69,992 patients) and the other included only main studies (n = 352, total enrollment 57,563 patients).

Results

Enrollment differed across different months of the year with peaks in spring and late fall. Enrollment accelerated over time (+27 patients per quarter for all studies and +16 patients per quarter for the main studies, p < 0.001) and was affected by the performance of large studies with target sample size > 1,000 (p < 0.001). These relationships remained significant in multivariate autoregressive modeling. A time series based on enrollment during the first 32 quarters could forecast adequately the remaining 21 quarters.

Conclusions

The fate and popularity of large trials may determine the overall recruitment of multicenter groups. Modeling of enrollment rates may be used to comprehend long-term patterns and to perform future strategic planning.

     

Automated breast sonography using a 7.5-MHz PVDF transducer: preliminary clinical evaluation. Work in progress

Breast ultrasound imaging performed with an automated machine was carried out in 89 patients, and images obtained with a conventional ceramic single-focus 4-MHz transducer and a 7.5-MHz polyvinylidene fluoride (PVDF) transducer were compared. The 7.5-MHz PVDF transducer improved overall image quality in 77% of patients and had equal penetration in 83%. It yielded greatly increased diagnostic information in 43% of 81 masses and improved visualization of calcification in 57% of 14 lesions in which calcium was visible on mammograms.