Role of CT in excluding major arterial injury after blunt thoracic trauma

The role of CT in the diagnosis of major vascular rupture following blunt decelerating chest trauma is controversial. Its value in excluding major arterial injury has not yet been determined. During a 12-month period we obtained dynamic enhanced thoracic CT studies in 20 patients with blunt decelerating thoracic trauma who had abnormal or equivocal mediastinal contours on chest radiographs. In all cases diagnosis was confirmed by either digital subtraction (18 patients) or conventional thoracic angiography (two patients). CT scans showed evidence of direct aortic injury in three patients and evidence of mediastinal hematoma in five others. Four of these eight patients had major arterial injury verified angiographically and at surgery. In two patients the CT scan was considered equivocal; both patients had normal thoracic angiograms. CT excluded direct vascular injury or mediastinal hematoma in 10 patients. All 10 had normal thoracic angiograms. This preliminary study suggests that, in patients sustaining blunt decelerating thoracic trauma, thoracic CT may be more valuable than chest radiography in excluding major vascular injury and, in some cases, may reduce the need for thoracic angiography.     

Obstetric risk assessment in rural practice

A study was undertaken to evaluate Coopland's obstetric risk index in a rural primary care setting. Information on 635 pregnant women cared for in a rural practice was collected prospectively. Adverse outcome was defined as perinatal death, birthweight less than 2500 g, 5-minute Apgar score less than 7, or newborn transferred to a level 2 or level 3 nursery. Forty-seven pregnancies (8.3%) had an adverse outcome. There was a clear relationship between risk score and probability of adverse outcome. Good sensitivity could be achieved only at the expense of a very high false-positive rate, however. The index can be used to identify a subgroup of women at relatively high risk for adverse outcome, but the majority of adverse outcomes will occur in women identified as low risk. The risk-scoring system in this population was no more effective than a policy that would refer all women with standard obstetric risk factors.     

Posaconazole salvage therapy allows successful allogeneic hematopoietic stem cell transplantation in patients with refractory invasive mold infections

We describe the clinical courses of 3 patients with hematologic malignancies (2 with acute myelogenous leukemia and 1 with multiple myeloma) who developed invasive fungal infections due to uncommon molds (Alternaria spp., Paecilomyces lilacinus, and Zygomycetes). Breakthrough invasive fungal infections of the sinus (n=1), lung (n=3), and pericardium (n=1) developed despite fluconazole prophylaxis and failed to respond to treatment with other licensed antifungal therapies, including amphotericin B (n=3), caspofungin (n=2), and voriconazole (n=3), and surgical intervention (n=2). Salvage therapy with posaconazole oral suspension resulted in successful outcomes in all 3 patients, who subsequently underwent allogeneic hematopoietic stem cell transplantation (HSCT) while on continued posaconazole therapy. The median duration of posaconazole treatment before HSCT was 5 months (range: 1.5-6 months). Posaconazole salvage therapy allowed successful allogeneic HSCT in 3 patients with refractory invasive mold infections.     

Percutaneous biopsy in evaluation of lung nodules.

Management of an indeterminate pulmonary nodule is a diagnostic challenge that commonly confronts primary care physicians and specialists. Patients often present with this radiographic finding in the course of an unrelated medical evaluation. We examined our institution's experience with percutaneous biopsy of lung nodules to determine the impact of this procedure on overall patient care. Although significant complications are uncommon, the expedience of percutaneous lung biopsy often supplants a surgical opinion prior to initiation of therapy without added diagnostic benefit or cost-savings. Hence, we caution practitioners to use this technique as an adjunct to diagnosis and not a substitute for multidisciplinary care.     

Sources of cortical rhythms change as a function of cognitive impairment in pathological aging: a multicenter study.

OBJECTIVE: The present study tested the hypothesis that cortical electroencephalographic (EEG) rhythms. change across normal elderly (Nold), mild cognitive impairment (MCI), and Alzheimer's disease (AD) subjects as a function of the global cognitive level. METHODS: Resting eyes-closed EEG data were recorded in 155 MCI, 193 mild AD, and 126 age-matched Nold subjects. EEG rhythms of interest were delta (2-4 Hz), theta (4-8 Hz), alpha 1 (8-10.5 Hz), alpha 2 (10.5-13 Hz), beta 1 (13-20 Hz), and beta 2 (20-30 Hz). EEG cortical sources were estimated by LORETA. RESULTS: Occipital delta and alpha 1 sources in parietal, occipital, temporal, and 'limbic' areas had an intermediate magnitude in MCI subjects compared to mild AD and Nold subjects. These five EEG sources presented both linear and nonlinear (linear, exponential, logarithmic, and power) correlations with the global cognitive level (as revealed by mini mental state examination score) across all subjects. CONCLUSIONS: Cortical EEG rhythms change in pathological aging as a function of the global cognitive level. SIGNIFICANCE: The present functional data on large populations support the 'transitional hypothesis' of a shadow zone across normality, pre-clinical stage of dementia (MCI), and AD.     

Same-day surgery preparation: reduction of pediatric patient arousal and distress through participant modeling

Twenty-six children (mean age = 5.5 years) were exposed to one of three surgery preparatory conditions: participant modeling alone (n = 9), participant modeling with mother (n = 8), and standard procedure control (n = 9). Children exposed to the modeling slide-tape without their mothers had significant reductions in physiological arousal after the slide-tape presentation, unlike children viewing the tape with their mothers and children exposed to the control condition. Both participant modeling groups exhibited significantly fewer distressful behaviors during recovery (postsurgery) than did control group children. Results are discussed with respect to previous medical preparation research. Implications of these findings concerning clinical application and future research are addressed.     

Antiviral immune responses modulate the nature of central nervous system (CNS) disease in a murine model of multiple sclerosis

Summary: In animals and in humans, T-cell therapy can cure advanced disseminated leukemia that would otherwise be fatal. The therapeutic effect of immune T cells is quantitative. As the dose of effector T cells is increased, survival is proportionately increased. Therefore, effective T-cell therapy is predicated on the ability to procure large numbers of immune effector T cells. By using cultured T cells, the number of immune T cells can be increased in vivo substantially above che level achievable by vaccination. The survival of cultured T ceils in vivo is dependent upon both the culture conditions used and the therapeutic regimens employed. Under appropriate conditions, cultured T ceils can proliferate in vivo in response to stimulation by antigen, distribute widely and survive long term to provide effector function and immunologic memory. Given that T cells recognize peptides. the need for immunization with tumor can be circumvented by immunization with peptide. Peptide-specific T cells and the progeny of single T-cell clones can provide the necessary cellular functions to eradicate disseminated murine leukemia. The ability of cloned T cells to similarly provide substantial measurable immunity in humans has been validated in clinical trials. By priming with peptides and by using established culture conditions, T-cell therapy can now be directed against virtually any antigen within the host T-cell repertoire. The major remaining question to be answered is which proteins and which peptides are the most suitable targets for T-cell therapy trials.     

Digestive cancer in relation to diet in Spain.

Dietary factors are widely considered to be largely responsible for the different cancer incidences observed in different populations. In the present study we investigated the possible influence of dietary habits on the incidence of digestive cancer in the provinces of Spain. Data on specific mortality due to digestive cancer corresponding to the period 1975 to 1985 were obtained from the Instituto Nacional de Estadística. Nutritional data on the different provinces were in turn gathered from the Instituto de Nutrición del Consejo Superior de Investigaciones Científicas. The information was processed by the SPSS statistical software package. Lifestyle and socio-cultural factors are found to influence dietary risk factors in digestive cancer, particularly among women. The most significant correlations with the different cancers studied corresponded to total energy intake (responsible for 27.4% of variance), animal fats, and smoked fish and coffee. The latter is related to oral and esophageal cancer in particular (responsible for 15.4% of variance). Consumption of carrots and frozen vegetables is responsible for 6.5% of variance, vs. 4.4% of variance for alcoholic beverages, sugar, and Vitamin D. Differences are noted between both the sexes and their relationship to the different cancers studied.