Mine Blast Injuries - Our Experience

Background

The sudden increase in incidence and magnitude of mine blast injuries prompted us to highlight the problem and its management.

Methods

The cases of mine blast injuries occurring during mining and demining in a particular geographical area were analysed. Total 27 cases of mine blast injuries occurred during mining or demining operations in a period of 13 months.

Results

Various body regions were involved in the mine blast injuries but the main brunt was borne by feet and legs followed by multiple body regions due to splinters. 14 patients underwent below knee (BK) amputation while 4 patients required through knee (TK) amputations. The effect of blast was so severe that most of the cases required 2 to 5 times wound debridements. The initial aggressive debridement / open stump amputation saved the limb and life of all patients.

Conclusion

A mine blast causes extensive injuries and psychological trauma. Management is needed urgently, surgery is difficult, and amputation is often inevitable. Maximum lives and limbs can be saved with aggressive debridement, repeated inspections and dressings under anaesthesia and definitive closure at optimum time.Key Words: Amputation, Antipersonnel mine, Crush syndrome, Debridements, Mine blast injury, Secondary missiles, Shrapenels     

Age-related changes in rat liver total protein and transferrin synthesis

An in vitro cell-free system from rat liver was designed to study the effect of age on the synthesis of total liver protein and on the synthesis of transferrln in the liver. Transferrin synthesis was determined by immunoassay. Total protein synthesis was greatest at 6 months of age and then decreased to 24 months of age. There was a significant increase in protein synthesis between 24 and 30 months of age. Transferrln synthesis followed this same general pattern except that no senescent increase in synthesis was observed.     

Sex-related differences in a gambling task and its neurological correlates

We investigated sex-related differences in task performanceand brain activity in the orbitofrontal cortex (OFC) and dorsolateralprefrontal cortex (DLPFC) during performance of a decision-makingtask (the Iowa Gambling Task). When men and women were examinedseparately, men activated extensive regions of the right lateralOFC and right DLPFC, as well as the left lateral OFC. In contrast,women activated the left medial OFC. Examining sex differencesdirectly, men showed better task performance and greater lateralizedbrain activity to the right hemisphere than women. This wasexemplified by greater activation in a large area of the rightlateral OFC of men during their performance of the Iowa GamblingTask. In contrast, women had greater activation in the leftDLPFC, left medial frontal gyrus and temporal lobe during thistask. Thus, brain mechanisms engaged by men and women when solvingthe same decision-making task are different. These observationsindicate that sex-related differences contribute to the heterogeneityobserved in both normal and abnormal brain functioning. Theseresults also provide further evidence of sexual dimorphism inneurocognitive performance and brain function.     

Anti-inflammatory effects of nitric oxide-releasing hydrocortisone NCX 1022, in a murine model of contact dermatitis

1 The concept that nitric oxide (NO) release can be beneficial in inflammatory conditions has raised more attention in the recent years, particularly with the development of nitric oxide-releasing anti-inflammatory drugs. There is considerable evidence that NO is capable of enhancing the anti-inflammatory benefits of conventional anti-inflammatory drugs. 2 Since hydrocortisone is the most widely used anti-inflammatory drug for the treatment of skin inflammation, we compared the anti-inflammatory effects of hydrocortisone to an NO-releasing derivative of hydrocortisone, NCX 1022, in a murine model of irritant contact dermatitis, induced by epidermal application of benzalkonium chloride. 3 Topical pre- and post-treatment with NCX 1022 (3 nmol) in C57BL6 mice not only reduced ear oedema formation in a dose-dependent manner, but also was significantly more effective than the parent compound during the initial stages of inflammation (from 1 to 5 h). NCX 1022, but not hydrocortisone, significantly inhibited granulocyte recruitment (tissue myeloperoxidase activity). Histological samples of mouse ears treated with NCX 1022 showed significant reduction in both the number of infiltrated cells and disruption of the tissue architecture compared to hydrocortisone-treated tissues. 4 With intravital microscopy, we observed that both pre- and post-treatments with NCX 1022 were more effective than hydrocortisone in terms of inhibiting benzalkonium chloride-induced leukocyte adhesion to the endothelium, without affecting the flux of rolling leukocytes or venule diameter. 5 These results suggest that by releasing NO, NCX 1022 modulates one of the early events of skin inflammation: the recruitment of leukocytes to the site of inflammation. Overall, we have shown that NO-hydrocortisone provided faster and greater protective effects, reducing major inflammatory parameters (leukocyte adhesion and recruitment, oedema formation, tissue disruption) compared to its parental compound.     

High conformality radiotherapy in Europe: thirty-one centres participating in the quality assurance programme of the EORTC prostate trial 22991

Today, conformality in radiotherapy is at the centre of many investments in equipment and staffing. To estimate the current situation within the European Organisation for Research and Treatment of Cancer (EORTC) conformal radiotherapy trial for prostate cancer, a technology questionnaire was designed to assess whether participating centres can comply with the required radiotherapy procedures of EORTC trial 22991, where a high dose is prescribed to the prostate. Questions covered various items of computed tomography, data acquisition, treatment planning, delivery and verification. All centres (n=31) replied to the questionnaire. All generate beam's eye views and dose volume histograms. All, but two, centres use digitally reconstructed radiographs to display images. The vast majority of the centres perform at least weekly treatment verification and half have access to individual in vivo dosimetry. The results of the questionnaire indicate that participating centres have access to the equipment and apply the procedures that are essential for conformal prostate radiotherapy. The technology questionnaire is the first step in the extensive quality assurance programme dedicated to this high-tech radiotherapy trial.     

Altered sonographic umbilical cord morphometry in early-onset preeclampsia

OBJECTIVE: To determine whether the sonographic morphometry of the umbilical cord components is different in preeclamptic compared with healthy pregnant women. METHODS: Consecutive women admitted after 20 weeks' gestation with the diagnosis of preeclampsia and whose fetus was normally grown (cases) were included in the study. Each case was matched to a healthy pregnant woman (controls) who had ultrasonography at the same gestational age (+/- 3 days). The sonographic cross-sectional areas of the umbilical cord and umbilical vessels were obtained in all patients and plotted on reference ranges. The umbilical artery resistance index was measured in all patients with preeclampsia. RESULTS: Twenty-five preeclamptic women were enrolled. The proportion of cases with a lean (below the tenth centile) umbilical cord was higher in cases than in controls (12 of 25 versus 1 of 25, P <.001). The Wharton's jelly area was lower in cases than in controls (median 105.8 mm(2) [range 49.6-212.9 mm(2)] versus 138.7 mm(2) [79.7-226.6 mm(2)], P =.024). The umbilical vein area was less in cases than in controls (median 29.2 mm(2) [range 8.0-52.8 mm(2)] versus 37.4 mm(2) [13.8-70.8 mm(2)], P =.032). The proportion of patients with a lean umbilical cord was higher among those with early-onset preeclampsia than in those with late-onset preeclampsia (12 of 19 versus 0 of 6, P =.014). CONCLUSION: Early-onset preeclampsia frequently is associated with reduced Wharton's jelly area and umbilical vein area compared with normal pregnancy. Sonographic umbilical cord morphometry might have clinical value for prompt identification of women at risk for preeclampsia.     

Transmandibular buccopharyngectomy after radiotherapy for orpharyngeal cancer

MATERIALS & METHODS: We present a retrospective study of 95 patients with recurrence of oropharyngeal carcinoma after exclusive radiotherapy. The treatment consisted in a salvage composite resection in all cases. RESULTS & DISCUSSION: Since the use of muscular flaps, the post-operative complications have been relatively minimised but the carcinologic results were disappointing: only 20% of patients were alive free of disease at 5 years. The main prognostic factors for overall survival were the stage rT of the relapse, the histologic invasion of the nodes and the quality of the resection. The anatomic site of relapse did not influence the survival. CONCLUSION: Our serie confirms the high frequency of second primary tumors in oropharyngeal cancers. Rigorous selection of patients for exclusive radiotherapy is mandatory to decrease the number of relapses and might avoid salvage surgery.     

A phenylalanine-arginine beta-naphthylamide sensitive multidrug efflux pump involved in intrinsic and acquired resistance of Campylobacter to macrolides

The macrolide erythromycin is the antibiotic of choice in the management of Campylobacter infections. Although mutation has been reported to account for resistance to the antibiotic, resistance may also be due to an efflux pump that extrudes the drug prior to reaching its target. Moreover, the efflux pump may be one that accommodates resistance to other related or unrelated drugs (multidrug resistance). We examined the possibility that resistance to erythromycin may involve an efflux pump whose presence may be identified by the use of the unique commercial inhibitor of the previously described efflux pumps phenylalanine-arginine beta-naphtylamide (PAbetaN). We showed that PAbetaN is able to significantly increase the susceptibility of the reference strain NCTC 11168 to erythromycin, suggesting that an efflux pump functions at a basal level in the reference wild type strain. Erythromycin-resistant isolates were tested for their response to PAbetaN treatment. Among the strains tested, resistance of three isolates to erythromycin was reduced to a level comparable to that of the susceptible strain when the strains were grown in the presence of this inhibitor. To conclude, besides mutations, erythromycin resistance in Campylobacter may also be due to an efflux mechanism sensitive to PAbetaN.     

Variations in the resting oxygen consumption of small babies

Over 200 measurements of the resting rate of oxygen consumption using an open-circuit method were made on 15 small babies nursed in their usual clinical setting during the first month of life. There were striking and persistent variations between babies that could not be explained by postnatal age, relationship to feed, sleep, or time of day. It was not possible from clinical examination to predict which babies had the higher or lower metabolic rates, except that babies who were light-for-dates generally had higher values. Because of these variations the appropriate thermal temperature for small babies cannot be predicted from average values adjusted for body weight and postnatal age alone.