Tire explosion injuries to the upper extremity

The influence of interferon (IFN) coadministered subcutaneously with the biomodulating agent folinic acid on the blood serum levels of 5-formyl-tetrahydrofolic acid (CHO-THFA) and the biotransformation into its main metabolite in the blood 5-methyltetrahydrofolic acid (CH3-THFA) was studied in patients receiving a chemotherapy with 5-fluorouracil. IFN causes a clear decrease of the serum concentrations of CHO-THFA and a statistically significant decrease of CH3-THFA concentrations (P < 0.01). The effect on serum concentrations could be observed in each patient, but in a different order of magnitude. As a consequence, the preadministration of IFN leads to a significant change in the basic pharmacokinetic parameters of both compounds: the mean area under the concentration-time curve is decreased at 27.4% for CHO-THFA (P < 0.025) and at 22.4% for CH3-THFA (P < 0.025), respectively. The total body clearance is elevated at 45.4% for CHO-THFA (P < 0.05) and at 23.4% for CH3-THFA (P < 0.05). The mean volume of distribution is increased by IFN at 38.2% for CHO-THFA (P < 0.025) and at 22.3% for CH3-THFA (P < 0.05). The nearly identical mean residence time in both groups indicates that CHO-THFA elimination is not affected by IFN. But the results prove a certain interaction between IFN and CHO-THFA. IFN accelerates the distribution of CHO-THFA as well as of its main metabolite from the blood into the tissue or activates the biotransformation of CHO-THFA into CH3-THFA inside the cells of the tissue. The extent of biotransformation of CHO-THFA into CH3-THFA, which takes place in the blood, is not influenced by IFN because percentage AUC-ratios CHO-THFA:CH3-THFA were 89.5:10.5% for the control group and 88.8:11.2% for the IFN group.     

Hand infections due to non-cholera Vibrio after injuries from St Peter's fish (Tilapia zillii)

We report 49 patients with a wide variety of hand infections, which developed after injuries from St Peter's fish (Tilapia zillii). Twenty-eight of 36 patients who had been operated on had non-cholera Vibrio infections, all identified as Vibrio vulnificus. The course in these patients was characterized by rapid spread of the infection with progressive necrosis of the tendon sheath, subcutaneous tissues and the skin. Two of them required amputations but the others had satisfactory functional results. Thirteen other patients were managed nonoperatively with intravenous antibiotics and all of them recovered completely.     

Burn injuries following explosion of car heaters

We report four cases of burn injuries inflicted by hot coolant after the explosion of the heating unit in four motor-vehicles of the same make and version, in similar circumstances while the patients were driving their cars. Burns of this type can cause considerable morbidity with an accompanying high risk of a traffic accident.     

Hand injuries in the users of hydraulic wood-cutters

This study has been carried out in order to suggest possible prophylactic recommendations. We investigated the type of injuries, the type of logsplitter used, the injury circumstances and the safety measures. Fifty-two patients were included. There were a total of 21 crushing injuries with amputations of fingers, hand, on forearm. Nine replantations, two revascularisations and seven amputations were carried out. Eighty-eight percent of the patients had their hand in the splitting area. Sixty-seven percent had not received any instructions on how to operate the machinery. In 58% of the cases two or more persons were operating the logsplitter and 40% of the machines had no emergency stop button. The hazards mentioned above influenced the injury frequence and severity. We therefore recommend improved prophylactic measures and precautions to be considered. For the old machines a campaign will be necessary, and for new logsplitters we recommend implementation of new standards.     

Hand ischemia due to "steal syndrome" in vascular access for hemodialysis

Among complications of vascular access operations, symptomatic steal syndrome is uncommon, but may lead to ischemia of the hand. Between 1983 and 1995, 5 patients with hemodialysis fistulas presented rest pain of finger necrosis with a wrist-brachial index of 0.56 (range 0.35 to 0.63) improving to 0.96 (range 0.72 to 1.05) after digital pressure of the fistula. Ligation of distal radial artery was performed in 3 patients with side-to-end radiocephalic fistula, while basilic vein was distally ligated in a case of side-to-side brachiobasilic fistula. A vein "banding" procedure reduce fistula flow and improved distal perfusion in one patient, while a true venous aneurysm of the cephalic vein was treated by excision and replacement with a tapered PTFE graft. Hemodynamic assessment is required during surgical correction, but it may also be useful in pre- and intra-operative evaluation of patients undergoing therapeutical AVFs to prevent arterial insufficiency of the hand.     

Disturbed eye movements after whiplash due to injuries to the posture control system

Self-reports after whiplash often indicate associations with vertigo and reading problems. Neuropsychological and otoneurological tests were applied to a group of whiplash patients (n = 26) and to a carefully matched control group. The whiplash group deviated from the control group on measures of eye movements during reading, on smooth pursuit eye movements with the head in normal position, and with the body turned to the left or to the right. Clinical, caloric, and neurophysiological tests showed no injury to the vestibular system or to the CNS. Test results suggest that injuries to the neck due to whiplash can cause distortion of the posture control system as a result of disorganized neck proprioceptive activity.     

Trends in motorcyclist and occupant fatalities and serious injuries due to traffic crashes

AIM: To describe trends in motorcycle traffic crashes and compare these trends in other crashes and vehicle registrations. METHOD: National fatality and public hospital inpatient data were used to select cases. Relative changes in both deaths and hospitalisations, and vehicle registrations were examined in each year during the period 1980-98. RESULTS: The results show that deaths and serious injuries to motorcyclists have declined substantially over the period 1980-1995. The trend in serious injuries to motorcyclists closely followed the trend in motorcycle registrations. The association was less evident for motorcyclist fatalities and for occupants there was no clear association with trends in registrations for either outcome. CONCLUSIONS: The reduction in motorcycle injuries has contributed substantially to our improved road safety record. We need to protect these gains but in order to do this we need a clear understanding of how they were achieved. Such an understanding is currently lacking.     

Falls, injuries due to falls, and the risk of admission to a nursing home

BACKGROUND: Falls warrant investigation as a risk factor for nursing home admission because falls are common and are associated with functional disability and because they may be preventable. METHODS: We conducted a prospective study of a probability sample of 1103 people over 71 years of age who were living in the community. Data on demographic and medical characteristics, use of health care, and cognitive, functional, psychological, and social functioning were obtained at base line and one year later during assessments in the participants' homes. The primary outcome studied was the number of days from the initial assessment to a first long-term admission to a skilled-nursing facility during three years of follow-up. Patients were assigned to four categories during follow-up: those who had no falls, those who had one fall without serious injury, those who had two or more falls without serious injury, and those who had at least one fall causing serious injury. RESULTS: A total of 133 participants (12.1 percent) had long-term admissions to nursing homes. In an unadjusted model, the risk of admission increased progressively, as compared with that for the patients with no falls, for those with a single noninjurious fall (relative risk, 4.9; 95 percent confidence interval, 3.2 to 7.5), those with multiple noninjurious falls (relative risk, 8.5; 95 percent confidence interval, 3.4 to 21.2), and those with at least one fall causing serious injury (relative risk, 19.9; 95 percent confidence interval, 12.2 to 32.6). Adjustment for other risk factors lowered these ratios to 3.1 (95 percent confidence interval, 1.9 to 4.9) for one noninjurious fall, 5.5 (95 percent confidence interval, 2.1 to 14.2) for two or more noninjurious falls, and 10.2 (95 percent confidence interval, 5.8 to 17.9) for at least one fall causing serious injury, but the association between falls and admission to a nursing home remained strong and significant. The population attributable risk of long-term admission to a nursing home for these three groups (the proportion of admissions directly attributable to the three categories of falls) was 13 percent, 3 percent, and 10 percent, respectively. CONCLUSIONS: Among older people living in the community falls are a strong predictor of placement in a skilled-nursing facility; interventions that prevent falls and their sequelae may therefore delay or reduce the frequency of nursing home admissions.     

An outbreak of needlestick injuries in hospital employees due to needles piercing infectious waste containers

OBJECTIVES: To investigate the cause of an outbreak of needlestick injuries (NSIs) in hospital employees. SETTING: A 700-bed university hospital. DESIGN: Outbreak investigation, laboratory evaluation of a medical waste disposal device, cost analysis. METHODS: Employee health department records were reviewed of workers suffering sticks from needles piercing fiberboard-contaminated material containers (CMCs). A laboratory evaluation of needle-puncture resistance properties of the CMCs was performed using a testing apparatus. The cost of a hospital waste disposal program using fiberboard CMCs was compared with the cost of a program using rigid plastic (polypropylene) boxes. RESULTS: During 40 months of surveillance in 1986 and from 1989 to 1991, only one NSI had occurred from a needle piercing a CMC. During 9 months in 1993, 13 NSIs occurred due to needles piercing CMCs (P < .001). No clinical illness resulted from the NSIs. The outbreak was halted by a temporary change to plastic (polypropylene) boxes for sharps disposal ($4.92 to $23.33/cu ft) until receipt of a box with a newly designed solid fiberboard liner ($1.25/cu ft). CMC liners used during the epidemic had a mean needle puncture resistance of 527 g, as compared with 660 g for liners used before the outbreak (P < .001). The new solid fiberboard liner has a mean puncture resistance of 1,765 g. A program of waste disposal using fiberboard CMCs was found to cost approximately one-seventh the cost of a program using plastic boxes for disposal of infectious waste. CONCLUSION: A program for infectious waste disposal using fiberboard CMCs can be safe and cost-effective if appropriate standards for puncture resistance are met.     

The age-dependent incidence of injuries due to road traffic accidents in Odense, Denmark from 1980 to 1992

The study was based on data concerning persons treated at Odense University Hospital as a result of road traffic accidents in the period 1980-92. Incidence rates of road traffic accident injuries were calculated on the basis of the population in Odense municipality. The study group included persons older or even 65 years of age, while persons younger than 65 years of age were used as a reference group.     

宝利通与爱立信进军视频通信市场

针对电信运营商的解决方案,应对商业及消费市场不断增长的视频通信需求     

Hand and lower arm injuries among New Zealand meat workers and use of protective clothing

AIM: To characterise work related hand and lower arm injuries among New Zealand meat processors and to identify practices used for protecting the hands of this group of workers. METHODS: These involved identifying and describing, from Department of Health national data, hand and lower arm injuries sustained by meat workers in New Zealand which resulted in hospitalisation during the period 1979-88, examining injury case records from selected meat processing plants for the period 1987-93 and identifying protective clothing practices in the meat processing industry. RESULTS: A significant increase in the hospitalisation rate for the period 1979-88 was identified (3.3 per 1000 to 5.3 per 1000; chi(2) = 33.14, df = 1, p < 0.001) with cutting and piercing being the most common injury event. Reported use of protective gloves and covers for the lower arm by meat workers was high (93% and 66% respectively) and also probably increased. CONCLUSION: Why injury rates rose during a period in which use of protective gloves reportedly increased is unclear. Possible explanations are discussed.     

Hand function related to age and sex

After adapting Jebssen's Test of Hand Function to Australian conditions, this study investigated his claim of no significant difference in hand performance among participants younger than 60 years, and determined whether age might be a factor when associated with sex. The method was to test 383 subjects of both sexes in 6 age groups. A 2-factor analysis with age and sex as factors yielded significant differences (p less than 0.01) for "grip strength" "manipulating small objects," and "moving large heavy objects," and indications of significance (p less than 0.05) for "card turning" and "moving large light objects." The sex factor showed males to be significantly better "grip strength," in "moving large heavy objects," and "large light objects," except in the 66-99 age interval where females were significantly better on teh last 2 variables. Females performed better on "writing" and were generally better in "manipulating small objects." These results suggest that the one set of norms given by Jebsen for 60 years and less for each sex, should be replaced by 5 or more, even though the differences were quite small when standard deviations were considered.