Radionuclide imaging and ultrasound in liver/spleen trauma: a prospective comparison

In a prospective blind study of liver/spleen trauma, 32 consecutive patients were evaluated by radionuclide imaging (99mTc-sulfur colloid) and gray-scale ultrasound. Six patients (19%) had inadequate sonograms due to injuries and pain. Thirteen (41%) were normal, 13 (41%) were abnormal with one technique or the other, and there was a discrepancy in 2 (6%). Of the 13 abnormal patients, 1 had a lacerated spleen, 2 had angiographic confirmation of a subcapsular hematoma, and 10 showed resolution on follow-up. Two patients with left-sided trauma had abnormal radionuclide scans of the liver; sonograms were initially normal in one of them, but subsequent imaging confirmed the abnormality. The authors feel that imaging with 99mTc-sulfur colloid should be the primary screening examination for liver/spleen trauma.     

Vascular trauma. Review of 10 years' experience

The records of 82 patients with vascular trauma, treated at the Departments of General Surgery of the Sahlgren's Hospital, G?teborg, between 1969-1978 were revised. Nine patients were female and 73 male. The most common type of trauma was stab wounds. The overall mortality was 10.9%, all being patients with major vascular trauma and/or multiple injuries. Fourteen cases were due to iatrogenic lesions. Of the remaining 68 patients, minor vessels were traumatized in 40 cases, and treated with ligation. In 28 patients some kind of reconstructive procedure was attempted, 23 of these patients survived. All reconstructive procedures in surviving patients were successful. In comparison with international experience, vascular trauma in Sweden seems to be very uncommon.     

The diagnostic and treatment characteristics of liver injuries in combined trauma

The results of diagnostics and treatment of the closed liver's injuries in 180 injured with combined trauma are analyzed. Was established, that the complexity of the diagnostics of the liver trauma and the heavy accompanying injuries, accomplishment of the diagnostic researches on the shock background, consciousness frustration, hemodynamics, breath, hypovolemia requires intensification of ultrasonic researches, computer tomography and laparoscopy, which reliability has made 91-95%. The injured with combined trauma and liver's injuries should be rendered the urgent specialized help. The volume of the operation on liver should be the most minimum, but reliable to stop hemorrhage. The surgical correction of other injuries of the abdominal and peritoneal cavities should be carried out. The operation is finished by cranial decompression trepanation and stabilization bone breaks of pelvis and extremities (under indications) as a preventive measure of shock, loss of blood and embolic complications.     

Microbiology of liver and spleen abscesses

To study the aerobic and anaerobic microbiology of liver and spleen abscesses and correlate the results with predisposing factors, potential causes and routes of infection, clinical and laboratory data of 48 patients with liver abscesses and 29 with spleen abscesses treated between 1970 and 1990 were reviewed retrospectively. In liver abscesses, a total of 116 isolates (2.4 isolates/specimen) was obtained; 43 were aerobic and facultative species (0.9 isolates/specimen) and 73 were anaerobic species or microaerophilic streptococci (1.5 isolates/specimen). Aerobic bacteria only were isolated from 12 (25%) abscesses, anaerobic bacteria only from eight (17%), and mixed aerobic and anaerobic bacteria from 28 (58%); polymicrobial infection was present in 38 (79%). The predominant aerobic and facultative isolates were Escherichia coli (11 isolates), Streptococcus group D (8), Klebsiella pneumoniae (5) and Staphylococcus aureus (4). The predominant anaerobes were Peptostreptococcus spp. (18 isolates), Bacteroides spp. (13), Fusobacterium spp. (10), Clostridium spp. (10) and Prevotella spp. (4). There were 12 isolates of micro-aerophilic streptococci. S. aureus and beta-haemolytic streptococci were associated with trauma; Streptococcus group D, K. pneumoniae and Clostridium spp. with biliary disease; and Bacteroides spp. and Clostridium spp. with colonic disease. In splenic abscesses, a total of 56 isolates (1.9 isolates/specimen) was obtained; 23 were aerobic and facultative species (0.8 isolates/specimen), 31 were anaerobic species or micro-aerophilic streptococci (1.1 isolates/specimen) and two were Candida albicans. Aerobic bacteria only were isolated from nine (31%) abscesses, anaerobic bacteria from eight (28%), mixed aerobic and anaerobic bacteria from 10 (34%) and C. albicans in two (7%); polymicrobial infection was present in 16 (55%). The predominant aerobic and facultative isolates were E. coli (5 isolates), Proteus mirabilis (3), Streptococcus group D (3), K. pneumoniae (3) and S. aureus (4). The predominant anaerobes were Peptostreptococcus spp. (11 isolates), Bacteroides spp. (5), Fusobacterium spp. (3) and Clostridium spp. (3). S. aureus, K. pneumoniae and Streptococcus group D were associated with endocarditis, E. coli with urinary tract and abdominal infection, Bacteroides spp. and Clostridium spp. with abdominal infection and Fusobacterium spp. with respiratory infection.     

Sucralfate in odontostomatology. Clinical experience

BACKGROUND: We here describe the pharmacological and pharmacodynamic characteristics of the molecule sucralfate, the aluminum subsalt of sucrose-8-sulphate, introduced in Japan in 1968 as a mucoprotector for the treatment of peptic ulcers. For many years, attempts have been made to broaden the therapeutic indications of this molecule as has happened in oral medicine. This paper describes the results of the clinical trials reported in the international literature which were designed to investigate the use of sucralfate in the treatment of mucositis secondary to radio- and/or chemotherapy and during the course of recurrent aphtous stomatitis (RAS). METHODS: The authors carried out a pilot study with the aim of testing the efficacy and the tolerability of two formulations of sucralfate (20% suspension and 1 gram chewable tablets) in a total of 28 patients [14 with RAS: group A; and 14 with burning mouth syndrome (BMS): group B]. Each group was further divided into two subgroups [A1, A2, B1, B2] of 7 patients each. RESULTS: The results obtained in the RAS patients were encouraging, with an improvement in symptomatology in respectively 71.4% and 42.8% of the patients in subgroups A1 and A2; a number of authors have previously suggested that this is due to a primarily mucoprotective mechanism similar to that occurring in patients with peptic ulcer. The results were less favourable in the BMS patients: symptoms improved in respectively 42.8% and 28.6% of the patients in subgroups B1 and B2, but worsened in 28.6% and 28.6% in teh same subgroups. CONCLUSIONS: In conclusion we believe that sucralfate can be considered a valid therapeutic support in the context of the lenitive pharmacological protocols in which it is currently used, but our results do not allow a definitive judgement of its efficacy in patients with BMS.     

Narrative completion in the treatment of trauma.

Describes the creation of narratives, the form for processing everyday experience. Complete narratives segment experience, link action and character, identify affect, and make meaning or sense. Trauma disrupts narrative processing by interfering with psychophysiological coordination, cognitive processes, and social connections. Incomplete narrative processing of traumatic experiences causes symptoms of posttraumatic distress. Two case illustrations of traumas that are not narratively complete suggest approaches for clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Non conventional treatment of human hydatidosis

BACKGROUND: Combined modality therapy in the treatment of retinoblastoma may decrease treatment-related morbidity and second tumor-associated mortality, while maintaining excellent tumor control rates. OBJECTIVE: To evaluate tumor control and potential synergy between intravitreally delivered carboplatin and external beam radiation therapy (EBRT), using a transgenic murine model of spontaneous heritable retinoblastoma. METHODS: Sixty-six mouse eyes from 4-week-old transgenic mice positive for the simian virus 40 large T antigen were evaluated. Thirty-three mice were treated with 5 intravitreal injections of carboplatin (ranging from 0.1-4.0 micrograms) combined with concurrent bilateral EBRT (ranging from 10-30 Gy) delivered in twice daily 5-Gy fractions. All eyes were followed up for treatment complications. Twelve weeks following final treatment, all eyes were enucleated, serial histologic sections obtained, and the eyes examined for the presence of retinoblastoma. RESULTS: No eye treated with 0.1 microgram of carboplatin and EBRT exhibited tumor control. Three (75%) of 4 mice receiving 1.0 microgram of carboplatin combined with 10-Gy EBRT had complete tumor control. Four (100%) of 4 mice receiving 1.0 microgram of carboplatin combined with 30-Gy EBRT had complete tumor control. Nine (100%) of 9 mice receiving 4.0 micrograms of carboplatin in combination with EBRT had complete tumor control. The chemotherapeutic enhancement ratio ranged from 1.07 to 3.24. CONCLUSIONS: Combined administration of intravitreal carboplatin and EBRT enhances local tumor control in murine retinoblastoma. Combining these treatment modalities may allow tumor control in selected patients with retinoblastoma while decreasing treatment-related morbidity and the mutagenic risks associated with radiation and systemic chemotherapy.     

Mild brain trauma in sports. Diagnosis and treatment guidelines

OBJECTIVES: To investigate whether infectious events around birth and during early infancy are likely to be of relevance in MS pathogenesis. SUBJECTS AND METHODS: Data are available from two regions in The Netherlands: Groningen (n=320) and Rotterdam (n=226). Simultaneous clustering in birth date and birth location of MS cases is tested by the methods of Mantel, Knox and Jacquez. RESULTS: No evidence was found for a space-time interaction between place and time of birth. CONCLUSION: Perinatal infectious events are unlikely to be a major factor in determining MS susceptibility.     

Clinical experience of trabeculotomy for the surgical treatment of aniridic glaucoma

OBJECTIVE: The purpose of this study is to determine the efficacy of initial trabeculotomy in the patient with aniridic glaucoma. DESIGN: Clinical charts were reviewed. PARTICIPANTS: Twenty-nine eyes of 16 patients with aniridia were studied. INTERVENTION: Glaucoma surgery was performed. As an initial procedure, trabeculotomy was performed in 12 eyes, other surgery was performed in 17 eyes (trabeculectomy, 5; goniotomy, 5; other, 7). MAIN OUTCOME MEASURES: Success was defined as an intraocular pressure (IOP) of 21 mmHg or lower, and no further surgery was performed. RESULTS: Ten (83%) of 12 eyes obtained IOP control after first (6 eyes) or second (4 eyes) trabeculotomy with a mean follow-up period of 9.5 years. Five eyes maintained visual acuity of 20/40 to 20/200. No serious complications were found after trabeculotomy. Three (18%) of 17 eyes were controlled with the first glaucoma surgery other than trabeculotomy (goniotomy, trabeculectomy, trabeculectomy combined with trabeculotomy, and Molteno implant). Good IOP control was obtained in 8 (47%) of 17 eyes after several surgeries with a mean follow-up period of 10.4 years. Four of 17 eyes became phthisical. CONCLUSION: This study suggests that trabeculotomy is the preferred initial operation for uncontrolled glaucoma with aniridia.     

Clinical evaluation of knee trauma

Clinical evaluation is of preponderant importance in the management of knee trauma. This evaluation is based on a systematic examination that should be well known to any practitioner treating such patients. During recent years, the symptomatology of knee trauma has required a large number of manipulations and clinical tests that can better identify the location and nature of anatomic lesions and specify their severity. The most important of these clinical signs and their pathological significance are presented in this study. Analysis of the symptoms, with grouping and concordance of the different tests, classifies the knee as having suffered "ligament", "patella", "meniscal" or other injury. Despite its limitations and sometimes too schematic nature, this classifications is highly informative and in most cases should be an indispensible step before prescribing radiology.     

Toxic trauma and chemical sensitivity: Clinical syndromes and psychotherapeutic strategies.

Describes the main forms of toxic stress and chemical sensitivity syndromes, considers relevant etiological models, and offers recommendations for psychotherapeutic management. An attempt is made to place these disorders in the broader context of stress response syndromes and neurosensitization phenomena. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The double-reversing Z-plasty in primary palatoplasty: operative experience and early results

The double-reversing Z-plasty of Furlow for closure of the soft palate was used in 34 children with various types of cleft palate. Mean age at repair was 12.8 months. Intraoperative experience was favorable, with acceptable operating time and blood loss. Length of hospitalization averaged 1.9 days. Postoperatively, two children experienced temporary stridor, which resolved within 24 to 48 hours. One child had dehiscence of the hard palate (Von Lagenbeck repair) 4 weeks postoperatively, and three children developed small oronasal fistulae. Early speech evaluation demonstrated adequate soft palate mobility in 33 of 34 patients, with observable velopharyngeal function. Twelve children had mild velar compromise, with eight exhibiting slight nasal air escape.     

Management of blunt liver trauma in children

INTRODUCTION: Management of liver trauma in childhood represents a rare but formidable challenge. METHODS: Clinical presentation, grade of liver injury and Injury Severity Score (ISS) were studied in 11 cases of blunt liver trauma to examine factors influencing outcome. RESULTS: Seven of the 11 children were injured severely and had an ISS greater than 16. Seven who were haemodynamically stable were treated without operation, but four required surgery for grade III, IV and V liver injuries. Two children had primary repair of hepatic lacerations. Perihepatic packing was employed in two other cases (grade IV and V injury) for uncontrollable haemorrhage. Delayed debridement and thrombectomy plus vena cava repair with suturing of liver lacerations in these patients obviated heroic efforts at primary repair. Nine children survived. There were two deaths from head and neck trauma. DISCUSSION: Selected children with liver trauma can be managed non-operatively using established trauma guidelines. Perihepatic packing is recommended in unstable patients with complex injuries, followed by delayed definitive repair.     

Clinical judgment, clinical training, and professional experience.

Reviews studies on training, experience, and clinical judgment. The results on the validity of judgments generally fail to support the value of on-the-job experience in mental health fields. The validity results do provide limited support for the value of training. Other results suggest that experienced clinicians are better than less experienced judges at knowing which of their judgments are likely to be correct and which are likely to be wrong. Reasons why clinicians have trouble learning from experience are given. Recommendations are made for improving training and clinical practice. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Clinical assessment and treatment of insomnia.

Insomnia is characterized by problems initiating and maintaining sleep—problems that often go unrecognized by psychotherapists as well as physicians. This article addresses central questions related to the diagnosis, assessment, and treatment of this problem. Differential diagnosis is focused upon as well as the comorbidity with psychiatric and organic disorders. The Assessment of Insomnia section covers different subjective measures of sleep: sleep diaries, sleep questionnaires, and sleep interview. Additionally, central objective sleep measures are included. In the Treatment of Insomnia section, the 6 most common behavioral interventions are presented together with the most current pharmacological approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)