Community characteristics and demographic information as determinants for a hospital-based injury prevention outreach program

HYPOTHESIS: To focus the efforts of a hospital-based injury prevention outreach program, information on patient demographics, community characteristics, and catchment area must be known. DESIGN AND SETTING: Evaluation of prospectively collected data maintained in the Trauma Registry of a level I university-based trauma center. PATIENTS AND MAIN OUTCOME MEASURES: Demographics, mechanism of injury, mortality, and home ZIP codes of patients admitted to the Adult Trauma Service, The Johns Hopkins Medical Institution, Baltimore, Md, were compared for 2 separate calendar years, at 2 years before (1995) and at 2 years after (2000) the implementation of a dedicated trauma program that includes an injury prevention outreach program. RESULTS: The list of common patient ZIP codes varied minimally from 1995 to 2000. The 18 most common ZIP codes represent (1) 80% of patients, (2) total area of 99 square miles (257.4 km2) (5.7-mile [9.1-km] radius), and (3) a region with a mean household income that is 67% of the statewide median. An increasingly disproportionate percentage of patients with gunshot wounds (GSWs) were the youngest patients (ages 15-24 years) treated by the Adult Trauma Service. While overall survival of trauma patients improved in 2000, no improvement was seen among patients with GSWs. Over half of the nonsurviving patients (37/65 [57%]) seen in 2000 and more than two thirds of patients with lethal GSWs (25/37 [67.6%]) were declared dead in the emergency department, suggesting nonpreventability from a clinical care standpoint. CONCLUSIONS: The catchment area represented by the bulk of patients admitted to a level I urban trauma center is compact and economically disadvantaged. While overall trauma mortality has decreased, GSWs are more lethal and prevalent in teenagers and young men. This identifies violence prevention as an area of emphasis.     

Acute regional cerebral blood flow changes caused by severe head injuries

To evaluate the changes in cerebral blood flow (CBF) that occur immediately after head injury and the effects of different posttraumatic lesions on CBF, 61 CBF studies were obtained using the xenon-computerized tomography method in 32 severely head-injured adults (Glasgow Coma Scale score (GCS) less than or equal to 7). The measurements were made within 7 days after injury, 43% in the first 24 hours. During the 1st day, patients with an initial GCS score of 3 or 4 and no surgical mass had significantly lower flows than did those with a higher GCS score or mass lesions (p less than 0.05): in the first 1 to 4 hours, those without surgical mass lesions had a mean CBF of 27 cc/100 gm/min, which rose to 44 cc/100 gm/min by 24 hours. Patients without surgical mass lesions who died tended to have a lower global CBF than did those with better outcomes. Mass lesions were associated with a high global CBF and bihemispheric contusions with the lowest flows. By 24 hours after injury, global blood flow increased in groups that originally had low flows and decreased in those with very high initial flows, such that by 36 to 48 hours, most patients had CBF values between 32 and 55 cc/100 gm/min. Lobar, basal ganglion, and brain-stem blood flow values frequently differed by 25% or more from global averages. Brain-stem CBF varied the most but did not correlate with clinical signs of brain-stem dysfunction. Double studies were performed at two different pCO2 values in 10 patients with various posttraumatic lesions, and the CO2 vasoresponsivity was calculated. Abnormal CO2 vasoresponsivity was found with acute subdural hematomas and defuse cerebral swelling but not with epidural hematomas. In patients without surgical mass lesions, the findings suggest that CBF in the first few hours after injury is often low, followed by a hyperemic phase that peaks at 24 hours. Global CBF values vary widely depending on the type of traumatic brain injury, and brain-stem flow is often not accurately reflected by global CBF values. These findings underscore the need to define regional CBF abnormalities in victims of severe head injury if treatment is intended to prevent regional ischemia.     

Removal of a thrombus from the sigmoid and transverse sinuses with a rheolytic thrombectomy catheter.

A rheolytic thrombectomy catheter was used to remove thrombus without thrombolytics from the sigmoid and transverse sinuses of a 34-year-old woman. Using small, high-flow fluid jets and Venturi-effect suction, this catheter allowed mechanical removal of thrombus. This technique may obviate the need for thrombolytic agents and the risks associated with their use.     

Xenon-enhanced computed tomography compared with [14C]iodoantipyrine for normal and low cerebral blood flow states in baboons

The correlation between the acute, invasive diffusible [14C]iodoantipyrine technique for cerebral blood flow and the noninvasive xenon-enhanced computed tomographic method has been assessed by simultaneous measurements in the baboon. Blood flows in small tissue volumes (about 0.125 cm3) were directly compared in normal and low flow states. These studies demonstrate a statistically significant association between the two methods (p less than 0.001). Similar correlations were obtained by both the Kendall (tau) and the Spearman (r) methods (r = 0.67 to 0.92, n greater than or equal to 19 for each study). The problems and limitations of such correlations are discussed.     

Adverse reactions to xenon-enhanced CT cerebral blood flow determination

Fourteen institutions performed 1,830 computed tomographic (CT) cerebral blood flow (CBF) examinations with 32% inhaled stable xenon. Respiratory rate delay greater than 10 seconds occurred in 3.6% of patients, with 83% of the delays lasting 10-15 seconds. There was no incident of prolonged respiratory difficulty. Headache (0.4%), seizures (0.2%), nausea and vomiting (0.2%), and change in neurologic status (0.1%) were uncommon, and there were no transient ischemic attacks. The CT CBF method with 32% inhaled stable xenon is thus associated with an acceptably low incidence of adverse reactions.     

Occipital neuralgia treated by intradural dorsal nerve root sectioning

The term occipital neuralgia was first used in 1821 to describe a characteristic pain in the region innervated by the greater occipital nerve. Since that time numerous authors have failed to reach a consensus concerning the presentation, cause, and treatment of this entity. Review of these previous works reveals that the term occipital neuralgia encompasses a collection of signs and symptoms which develop secondary to a variety of different disease processes. We have treated nine patients suffering from severe occipital pain with associated C₂ hypesthesia, unilateral retro-orbital pain, and occipital or C₂ tubercle trigger points by intradurally sectioning the C₁ -C₄ dorsal rootlets (C₄ if shoulder pain existed). All patients had been treated previously with various modalities without success. This paper discusses the results obtained in these patients.     

Behavioral effects of pubertal anabolic androgenic steroid exposure in male rats with low serotonin

The goal of this study was to assess the interactive effects of chronic anabolic androgenic steroid (AAS) exposure and brain serotonin (5-hydroxytryptamine, 5-HT) depletion on behavior of pubertal male rats. Serotonin was depleted beginning on postnatal day 26 with parachlorophenylalanine (PCPA 100 mg/kg, every other day); controls received saline. At puberty (P40), half the PCPA-treated rats and half the saline-treated rats began treatment with testosterone (T, 5 mg/kg, 5 days/week). Behavioral measures included locomotion, irritability, copulation, partner preference, and aggression. Animals were tested for aggression in their home cage, both with and without physical provocation (mild tail pinch). Brain levels of 5-HT and its metabolite, 5-hydroxyindoleacetic acid (5-HIAA), were determined using HPLC. PCPA significantly and substantially depleted 5-HT and 5-HIAA in all brain regions examined. Chronic T treatment significantly decreased 5-HT and 5-HIAA in certain brain areas, but to a much lesser extent than PCPA. Chronic exposure to PCPA alone significantly decreased locomotor activity and increased irritability but had no effect on sexual behavior, partner preference, or aggression. T alone had no effect on locomotion, irritability, or sexual behavior but increased partner preference and aggression. The most striking effect of combining T+PCPA was a significant increase in attack frequency as well as a significant decrease in the latency to attack, particularly following physical provocation. Based on these data, it can be speculated that pubertal AAS users with low central 5-HT may be especially prone to exhibit aggressive behavior.