Achieving hemostasis with topical hemostats: making clinically and economically appropriate decisions in the surgical and trauma settings

Achieving hemostasis is a crucial focus of clinicians working in surgical and trauma settings. Topical hemostatic agents—including mechanical hemostats, active hemostats, flowable hemostats, and fibrin sealants—are frequently used in efforts to control bleeding, and new options such as hemostatic dressings, initially used in combat situations, are increasingly being used in civilian settings. To achieve successful hemostasis, a number of vital factors must be considered by surgeons and perioperative nurses, such as the size of the wound; bleeding severity; and the efficacy, possible adverse effects, and method of application of potential hemostatic agents. Understanding how and when to use each of the available hemostatic agents can greatly affect clinical outcomes and help to limit the overall cost of treatment.     

Victim of Carbon Monoxide Poisoning Identified by Carbon Monoxide Oximetry

Background: Carbon monoxide (CO) is known as a leading cause of unintentional poisoning death in many countries. Diagnosis is usually made by measuring carboxyhemoglobin (COHb), but due to the non-specific symptoms, the crucial step is considering CO poisoning. A possible solution might be screening emergency department (ED) patients. A cutaneous sensor that measures oxygen and CO saturation simultaneously could accomplish that. Objectives: We report a case in which CO-oximetry screening helped to identify CO poisoning in a patient with otherwise non-specific complaints presenting to a busy university hospital ED. Case Report: A 53-year-old woman presented to our ED, reporting non-specific but common symptoms including emesis and diarrhea, one-sided headache, paresthesia, and palpitations. Whereas conventional pulse oximetry showed normal results, a COHb level of 28% was measured using a CO-oximeter. This allowed a diagnosis of CO poisoning to be made at admission. The patient was treated with 100% oxygen continuous positive airway pressure ventilation, and CO washout was monitored continuously and non-invasively. In the meantime, the local fire department was alerted and found a malfunctioning water heater as the source of CO in the patient's residence. As COHb fell to normal levels and the patient reported feeling well, she was discharged the next day. Conclusion: CO-oximetry served as a powerful tool in both identifying and monitoring a CO-poisoned patient in a busy ED. Future studies should address possible sources of error using this method on a long-term basis and its level of acceptance by ED staff.     

GABAA receptor‐ and GABA transporter polymorphisms and risk for essential tremor

Background: Clinical features and animal models of essential tremor (ET) suggest gamma‐aminobutyric acid A receptor (GABA_AR) subunits and GABA transporters as putative candidate genes. Methods: A total of 503 ET cases and 818 controls were investigated for an association between polymorphisms in 15 GABA_AR and four GABA transporter genes and ET. Results: Nine nominally significant tagging SNPs (P values from 4.9 × 10⁻² to 5.2 × 10⁻⁴) were found in the hypothesis generation stage. Five SNPs were followed up in a second verification stage but failed to reach significance. (P values from 0.30 to 0.77). Discussion: In our samples, no evidence of association between GABA_AR and GABA transporter genes with ET was detected. Further studies are necessary to clarify the role of these genes in ET.     

Personality disorders in gay, lesbian, bisexual, and transgender chemically dependent patients

This study sought to examine personality disorders and their related clinical variables in a sample of gay, lesbian, bisexual, and transgender (GLBT) individuals with substance use disorders. Study participants were 145 GLBT patients who were admitted to a residential dual diagnosis chemical dependency treatment program. A total of 136 (93.8%) had at least one personality disorder. The most common personality disorders were borderline (n = 93; 64.1%), obsessive-compulsive (n = 82; 56.6%), and avoidant (n = 71; 49.0%) personality disorders. Preliminary data suggest that there is a high prevalence of personality disorders in the GLBT population undergoing chemical dependency treatment.     

Development of the Crohn's disease digestive damage score, the Lémann score

Crohn's disease (CD) is a chronic progressive destructive disease. Currently available instruments measure disease activity at a specific point in time. An instrument to measure cumulative structural damage to the bowel, which may predict long-term disability, is needed. The aim of this article is to outline the methods to develop an instrument that can measure cumulative bowel damage. The project is being conducted by the International Program to develop New Indexes in Crohn's disease (IPNIC) group. This instrument, called the Crohn's Disease Digestive Damage Score (the Lémann score), should take into account damage location, severity, extent, progression, and reversibility, as measured by diagnostic imaging modalities and the history of surgical resection. It should not be "diagnostic modality driven": for each lesion and location, a modality appropriate for the anatomic site (for example: computed tomography or magnetic resonance imaging enterography, and colonoscopy) will be used. A total of 24 centers from 15 countries will be involved in a cross-sectional study, which will include up to 240 patients with stratification according to disease location and duration. At least 120 additional patients will be included in the study to validate the score. The Lémann score is expected to be able to portray a patient's disease course on a double-axis graph, with time as the x-axis, bowel damage severity as the y-axis, and the slope of the line connecting data points as a measure of disease progression. This instrument could be used to assess the effect of various medical therapies on the progression of bowel damage.     

Chemical Genetics Identifies Small-Molecule Modulators of Neuritogenesis Involving Neuregulin-1/ErbB4 Signaling

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