Caring for the major trauma victim: the role for radiology

Two innovations have improved the care of the major trauma victim in the past 20 years. Both depend on active radiologist participation. The first has been the progressive nationwide development of the Emergency Medical Service System, which identifies trauma centers by a process of categorization, regionalization, and verification. The hospital must be staffed and equipped to perform computed tomography, angiography, and sonography. Trauma centers effectively reduce morbidity and mortality of the accident patient. The second innovation has been the intensive use of computed tomography (CT) for immediate patient evaluation. CT surpasses other imaging methods in examination for craniocerebral, abdominal, spinal, pelvic, and facial trauma. In craniocerebral trauma, the precise diagnosis afforded by CT reduces the fatality rate by permitting early surgical intervention. In abdominal trauma, CT examination supports nonoperative management of hemodynamically stable patients with solid organ injury. In spinal, pelvic, and facial injuries, CT provides diagnostic information not available with conventional radiography.     

Embolization in cataclysmal hemorrhage caused by squamous cell carcinomas of the head and neck

Cataclysmal hemorrhage occurred in eight patients with known aggressive squamous cell tumors of the head and neck. Angiography showed neovascularity, narrowing, beading of affected arteries, and pseudoaneurysms. Postembolization residual stump formation was seen in a few patients. A total of 11 embolization procedures were performed in these eight patients. Embolization materials included polyvinyl alcohol, isobutyl-2-cyanoacrylate, and detachable balloons. Survival times ranged from 5 to 274 days, with no deaths as a direct result of hemorrhage. Only one severe complication following embolization was noted.     

Neurodevelopmental outcome of very low birth weight babies admitted to a Malaysian nursery

OBJECTIVE: To examine the prevalence and pattern of neurodevelopmental handicap at 2 years of age in very low birth weight infants (VLBW) admitted in 1993 to a level 3 Malaysian nursery. METHODS: All VLBW babies born in the hospital or referred for neonatal care during 1993 were enrolled prospectively in the study. At 2 years of age development was assessed using the Griffiths mental scales. Neurological, hearing and visual assessments were graded into five groups according to functional handicap. Control infants were randomly selected during attendance at a primary health care clinic. RESULTS: One hundred and fifty VLBW infants were admitted and 82 (54.6%) survived to 2 years, of whom 77 (93.9%) were assessed. The mean General Quotient (GQ) on the Griffiths Scales was 94 (15.7) for the study group and 104 (8.3) for the 60 controls. For GQ, 21 (27.3%) of the study population were 1 or more SD below the mean (18 between 1 and 2 SD and 3 > 2 SD) compared with 1 (1.6%) of the controls who was 1-2 SD below the mean. Visual impairment occurred in 2 study infants and none of the controls. There was no hearing impairment in either group. Cerebral palsy occurred in 3 (1 mild and 2 moderate-severe) of the study group and none of the controls. Functionally 18 (23.3%) of the study group had mild handicap, 1 (1.3%) moderate, 2 (2.5%) severe, 2 (2.5%) multiply severe and 54 (70.2%) were normal. CONCLUSION: Although survival was low, overall rates of functional handicap were similar to those reported in developed countries but the proportion with moderate or severe handicap was low.     

抗消化性溃疡病药物杂环甲醛缩氨(硫)脲和酰胺的合成和构效分析

呋喃唑酮是我国临床上发现并使用的抗消化道溃疡药物。为优化其活性,对呋喃唑酮分子中的硝基呋喃环和噁唑酮环进行了结构修饰和改造。合成的28个化合物的生物活性表明,用呋喃、噻吩、吡咯或甲基吡咯代替硝基呋喃环,用氮脲、氨硫脲和芳酰肼等结构片断替代噁唑酮环,均可引起活性和毒性的变化。构效关系分析表明,化合物的水溶解性和羰基的电荷密度是影响化合物活性的重要因素。     

Increased granulocyte aggregation in vitro in diabetes mellitus

Having previously shown an increase in white blood cell (WBC) aggregation in groups known to have a high incidence of cardiovascular events, we compared 28 patients with diabetes mellitus and no history or clinical evidence of macrovascular disease with 28 age- and sex- matched normal controls. Patients and controls had blood taken in the morning and analysed for WBC aggregation in vitro using a whole blood technique. WBC aggregation was significantly higher in the diabetic group compared with the normal controls (mean +/- SD 31.10 +/- 10.26% vs. 25.7 +/- 9.38%; p < 0.04, Student t-test). WBC aggregation predates the appearance of clinical symptoms of macrovascular disease in diabetes.      

Cavernosal venocclusive insufficiency in male impotence: evaluation of degree and location

The author's experience with 72 patients with impotence, one patient with Peyronie disease (no impotence), and two healthy volunteers indicates that incompetence of the venocclusive mechanism of the corpora cavernosa is probably the most common cause of vasculogenic impotence. Manometric and angiographic studies are the key to diagnosis but only when performed while the venocclusive mechanism is activated. Activation is achieved by intracavernosal injection of a papaverine-phentolamine mixture. Pharmacomanometry, performed with the newly developed pharmacologic maintenance erectile flow (PMEF) method, enabled precise quantitation of the leak at a given cavernosal pressure. A new appreciation of the limited volume of normal flow in the cavernosal arteries indicates that cavernosal leak in the range of only 20 ml/min is probably capable of contributing to impotence. Pharmacocavernosography enabled identification of sites of leakage (key information in the planning of surgical correction) but was unreliable in the evaluation of the severity of leakage.