Factors affecting mortality of critical care trauma patients

Background

Critically-ill trauma patients have a high mortality.

Objective

To study the factors affecting the mortality of ICU trauma patients treated at Al-Ain Hospital, United Arab Emirates (UAE).

Methods

All trauma patients who were admitted to the ICU were prospectively collected over three years (2003–2006). Univariate and multivariate analysis were used to compare patients who died and who did not. Gender, age, nationality, mechanism of injury, systolic blood pressure and GCS on arrival, the need for ventilation, presence of head or chest injuries, AIS for the chest and head injuries and the ISS were studied.

Results

There were 202 patients (181 males). The most common mechanism of injury was road traffic collisions (72.3 %). The overall mortality was 13.9%. A direct logistic regression model has shown that factors that affected mortality were decreased GCS (p < 0.0001), mechanism of injury (p = 0.004) with burns having the highest mortality, increased age (p = 0.004), and increased ISS (p = 0.02). The best GCS that predicted mortality was 5.5 while the best ISS that predicted mortality was 13.5.

Conclusion

Road traffic collision is the most common cause of serious trauma in UAE followed by falls. Decreased GCS was the most significant factor that predicted mortality in the ICU trauma patients.     

American Paraplegia Society 48th Annual Conference • September 2002 Poster Presentations #P1-P30 Sci Research • Pharmacology • Technology • Education

Abstract

Background/Objective: Salmonella spondylodiskitis is an uncommon type of vertebral infection. The aim of this study was to present a case of progressive paraplegia caused by Salmonella spondylodiskitis and epidural abscess after endoscopic cholecystectomy.

Methods: The patient underwent posterior instrumentation and posterior fusion between T6 and T12, hemilaminotomies at levels T8-T9-T10, and drainage of the abscess. Through a left thoracotomy, anterior T8-T10 corpectomy, debridement, anterior stabilization, and fusion were conducted.

Results: Fifteen months later, final follow-up showed no complications secondary to the vertebral and hip surgeries, and neurological status improved to Frankel grade E. Laboratory investigations showed no evidence of Salmonella infection.

Conclusion: Immunocompromised patients who undergo endoscopic intervention are vulnerable to Salmonella infections. One must consider Salmonella infection in those who develop acute progressive spondylodiskitis.     

Does pedicle screw fixation under age 5 cause spinal canal narrowing? A CT study with minimum 5 years follow-up

Purpose

The aim of this retrospective study was to evaluate the changes in the vertebral body and spinal canal area in a group of patients who had pedicle screw fixation under age 5 for the treatment of congenital spinal deformity at least 5 year follow-up.

Methods

11 patients who had been operated due to spinal deformity under age 5 with who had a CT examination at least 5 years after the initial operation were included in the study. All patients underwent hemivertebrectomy and transpedicular fixation procedures at an average age of 3.18 years (range 2–5 years). All had preoperative CT to evaluate the congenital deformities. Measurements were done at the instrumented vertebrae as well as the un-instrumented ones above and below them to evaluate; vertebral body parameters, pedicle parameters and spinal canal area of upper instrumented vertebra (UIV), lower instrumented vertebra (LIV), upper adjacent un-instrumented vertebra and lower adjacent un-instrumented vertebra.

Results

The average follow-up was 7.2 (range 5–12) years. Six of the patients were over age 10 during the final CT examination while 5 were at age 7. Female-to male ratio was 8–3. Measurement of all the parameters in 22 instrumented and 22 non-instrumented segments showed a proportional increase rather than a decrease at each segment. The percentage of canal area growth at UIV and LIV was 21 and 17.5 %, respectively.

Conclusion

Pedicle screw instrumentation has no adverse effect on further spinal body, pedicle and canal growth and does not result in iatrogenic spinal canal stenosis.

     

The initial phase of graft‐versus‐host disease is associated with a decrease of CD4+CD25+ regulatory T cells in the peripheral blood of patients after allogeneic stem cell transplantation

The mechanisms that induce and control the alloimmune inflammation of graft‐versus‐host disease (GvHD) after allogeneic stem cell transplantation (allo‐SCT) are still incompletely understood. In the murine system, GvHD can be suppressed by CD4⁺CD25⁺ regulatory T cells (TREG), which are generally involved in the suppression of inflammatory reactions. A disruption of the homeostasis between TREG and conventional T cells might therefore be associated with the inflammatory reactions of GvHD. We repetitively measured the frequency of TREG in the peripheral blood of 29 patients within the first 71–373 days after allo‐SCT and correlated the results with the clinical course. We demonstrate that the initial phase of GvHD is associated with a significant reduction of TREG in the peripheral blood, while at later stages and during intensified immunosuppressive therapy, increased numbers of TREG appear. These results might indicate a pathogenic role for reduced numbers of TREG in the induction of human GvHD.     

Trizivir^TM治疗80例HIV／AIDS患者临床研究

目的1．评估Trizivir^TM（AZT＋3TC＋ABC，TZV）治疗中国HIV／AIDS患者的疗效和安全性；2．HIV／AIDS患者的依从性；3．考察中国社区内HIV／AIDS患者服用固定剂量三联片治疗的可行性。方法80例HIV／AIDS患者进入治疗组。是一项单中心、开放式、无对照的临床试验。患者接受36个月的治疗，在治疗1，2，3，4，5，6，9，12，18，24，30和36个月按时到门诊随访。结果57例（71．3％）患者完成36个月治疗随访，23例（28．7％）在治疗过程中因药物不良反应、机会性感染复发、依从性不好或治疗失败而退出。57例治疗36个月后，CD4＋ T淋巴细胞计数平均增加252／μL，93．0％的患者显示病毒载量〈400拷贝／mL。在36个月的治疗期间，有4例患者出现耐药。结论TZV抗病毒效果显著，对于病毒载量〉500000拷贝／mL的患者也有很好的效果，CD4＋T淋巴细胞计数均显示明显增加。TZV不良反应较少，与其他药物的相互作用较少，服用方便，患者服药依从性好，对某些患者尤其有毒瘾者不失为一种可以选用的治疗方案。     

Hemodynamic Effects and Clinical Determinants of Defibrillation Threshold for Transvenous Atrial Defibrillation Using Biatrial Biphasic Shocks in Patients with Chronic Atrial Fibrillation

We assessed the relationship between the hemodynamic changes and shock intensity in transvenous atrial defibrillation for chronic AF. The correlation between the clinical profile and atrial DFT and the factors predicting maintenance of SR after successful defibrillation were also investigated. Atrial defibrillation using entirely transvenoas leads has been investigated as an alternative means of managing patients with AF. However, the hemodynamic consequence of this technique and the clinical factors predicting defibrillation efficacy have not been evaluated. Thirty-seven patients with chronic AF (4 weeks to 60 months) underwent transvenoas atrial defibrillation. Defibrillation was performed by delivering R wave synchronized, biphasic (3/3 ms) shocks with step-up voltages (20–400 V) between defibrillation catheters in the anterolateral right atrium and the distal coronary sinus. Clinical profile of the patients, the DFT, arterial blood pressure, and RH interval during defibrillation and the 6-month recurrence rate were determined. SR was restored in 33 (89%) of 37 patients and the DFT was 3.7 ± 1.4 J (317 ± 58 V). Transvenous atrial defibrillation resulted in a mild reduction in blood pressure (6 ± 10 mmHg), but substantial prolongation of longest postshock RR intervals (507 ± 546 ms), which were significantly related to the shock intensity (r = 0.5, P < 0.001). There was no ventricular proarrhythmia. The patients'age, body weight, duration of AF, left atrial diameter, and ejection fraction were not related to the success of defibrillation, not the 6-month maintenance rate of SR (39%). However, the patients'age was related to DFT. Apart from transient reduction in blood pressure and shock related pauses that may require backup pacing, transvenous biatrial defibrillation was a highly effective and well-tolerated technique. The absence of clinical determinant for successful defibrillation suggests that restoring SR by transvenous atrial defibrillation could be attempted in most patients with chronic AF.     

The role of posterior instrumentation and fusion after anterior radical debridement and fusion in the surgical treatment of spinal tuberculosis: experience of 127 cases

Long periods of immobilization, progressive kyphosis and graft failure are the major postoperative problems encountered after anterior radical surgical treatment for tuberculosis of the spine. Posterior fusion and instrumentation can be an effective solution for these problems. Effectiveness of posterior fusion and instrumentation was investigated in this study on the basis of the cases with anterior procedure only, and with combined anterior-posterior procedures. One hundred twenty-seven cases of tuberculosis of the spine were surgically treated between 1987 and 1995. All had either 1 or more of conditions such as spinal cord compression and neurological deficit, vertebral body collapse and kyphosis, or wide paravertebral abscess unresponsive to medical treatment. Of these, 57 had only anterior radical procedure between the years 1987 and 1993. Seventy cases had posterior instrumentation and fusion after the anterior procedure between the years 1991 and 1995. In about two third of the patients (81) autogenous iliac strut graft and in one third of them (40) autogenous fibular strut graft (cases with more than 2 level involvement) was used along with rib grafts after debridement. Twenty-one of the 57 patients who had only anterior procedure demonstrated a postoperative increase of kyphosis of more than 10 degrees. Increased kyphosis was due to graft slippage in 3, resorption in 2 and subsidence in 16 patients. No such increase or graft failure was noted in cases of combined anterior-posterior procedure. The difference in terms of kyphosis was found to be statistically significant (P=0.047). Anterior radical debridement and strut graft is the golden standard in the surgical treatment of spinal tuberculosis, but it should always be accompanied by posterior instrumentation and fusion to shorten the immobilization period and hospital stay, obtain good and long lasting correction of kyphosis, and prevent further collapse and graft failure.     

Hematin and Bilirubin Binding to Human Serum Albumin and Newborn Serum

ABSTRACT. In jaundiced newborn infants, hemolytic disease is considered a risk factor for kernicterus due to the suspected competition between bilirubin and other hemoglobin breakdown products for albumin binding. We have studied the effect of hematin on bilirubin-albumin binding using the peroxidase assay and a light-scattering technique for measuring unbound bilirubin. Our results show that hematin does not affect bilirubin-albumin binding. To determine if other albumin binding functions are affected by hematin, we used a microdialysis rate technique employing two ligands, diazepam and monoacetyldiaminodiphenyl sulfone (MADDS). Hematin does not utilize the diazepam binding function of albumin, but does decrease the albumin binding of MADDS. The results of this study indicate that the MADDS and bilirubin binding functions are not identical. The clinical usefulness of reserve albumin equivalent determination using MADDS is discussed.