Hip impact velocities and body configurations for voluntary falls from standing height

OBJECTIVE: To determine prevalence of various pheno- and genotypes of Serpulina sp in young pigs in relation to diarrhea and feed medication in Swedish pig-rearing herds. DESIGN: Isolation of spirochetes. Phenotypical and genotypical classification. SAMPLE POPULATION: Young pigs (n = 358) in 19 pigrearing herds. PROCEDURE: Serpulina isolates were classified according to a biochemical scheme based on hemolysis, indole production, hippurate hydrolysis, and alpha-galactosidase, alpha-glucosidase, and beta-glucosidase activities. The 16S rRNA sequences for 10 of the field strains and 2 type strains of Serpulina spp were aligned and compared. Minimum inhibitory concentrations of olaquindox for 9 of the strains were determined. RESULTS: Weakly beta-hemolytic intestinal spirochetes (WBHIS) were isolated from 17 of the herds and 65% of the samples. More than 1 phenotype of WBHIS was found in 12 of the 19 herds. S hyodysenteriae was not isolated in any of the herds. Hippurate-positive WBHIS were isolated in 6 of 7 herds affected by diarrhea, but in only 1 of 8 herds without diarrhea. Hippurate-positive strains were closely related to the pathogenic strain P43 if judged from sequence comparisons. Strains with the same biochemical profile isolated within a herd had identical sequences, but when isolated from different herds, sequence differences were observed. The prevalence of WBHIS was reduced in herds medicated with olaquindox. Investigated field strains had minimum inhibitory concentration values < or = 1 microgram/ml for olaquindox. CONCLUSION: The presence of WBHIS, with the ability to hydrolyze hippurate, was related to diarrhea in pig herds. CLINICAL RELEVANCE: Potentially pathogenic WBHIS can be distinguished from nonpathogenic strains by the hippurate hydrolysis test.     

Rapid infusion system for neurosurgical treatment of massive intraoperative hemorrhage

Using an illustrative case of severe closed head injury that resulted in a posterior fossa epidural hematoma (EDH) and supratentorial epidural/subdural hematomas (SDH), the massive blood losses associated with operative repair of the torn sigmoid sinus and the significant fluid losses associated with refractory diabetes insipidus were treated by the intraoperative use of the Rapid Infusion System (RIS, Haemonetics). The RIS can rapidly infuse warm blood, crystalloid, or colloid at rates up to 1.5 L/min, thereby limiting the commonly associated hypotension, hypothermia, and coagulopathies. During the suboccipital craniectomy for evacuation of the EDH and repair of the sigmoid sinus, the patient required 18 units of blood replacement secondary to a large tear in the sigmoid sinus. During a separate craniotomy for evacuation of the SDH, the patient also developed diabetes insipidus, which increased the operative fluid replacement to 39 L. Despite these massive blood and fluid losses, the RIS limited the hypotension to less than 2 min and prevented hypothermia and the frequently associated coagulopathies. When used in a neurosurgical setting associated with massive blood and/or fluid losses, the RIS accomplishes three important objectives: (1) rapid infusion of intravenous fluids for maintaining perfusion pressure, (2) rapid warming of fluids despite high intravenous infusion rates of cold crystalloids, thereby preventing intraoperative hypothermia, and (3) continuous monitoring of infusion rates and totals.     

Prenatal care in the inner-city: a cooperative effort

PAHCF and Women and Infants Hospital have been working together for many years to provide high quality, accessible prenatal and obstetrical care to low-income, inner-city residents in the Providence area. Many of these patients have multiple medical, social, and nutritional problems that place them at increased risk for poor pregnancy outcomes. The PAHCF sites offer convenient locations, evening hours, and culturally-sensitive, bilingual staffs; together the five sites provided prenatal care to nearly 1200 patients last year. Women and Infants Ambulatory Care Department provided prenatal care to an additional 1800 women in 1991, including all high risk patients referred for complications or diagnostic evaluations. All patients deliver at Women and Infants, then return to their original source of care for postpartum followup and family planning services. Patient records are readily transferred between the sites, eliminating the need for unnecessary duplication of information or laboratory tests. This close collaboration is mutually beneficial to both the health care providers and the patients whom they serve.     

Quality of life following percutaneous transluminal angioplasty for claudication

Basal cell carcinoma (BCC) is the most common type of skin cancer and the incidence of BCC is expected to rise, with increased demand on dermatology resources. Little is known of the effect on people's lives of having skin cancer. The aim of this study was to quantify the handicap caused gy basal cell carcinomas before and after therapy. Forty-four patients (22 males, mean age = 65 yrs, range = 35-81 yrs) with 48 BCCs were recruited and 37 patients completed the study. Each patient completed the UK Sickness Impact Profile (UKSIP) and the Dermatology Life Quality Index (DLQI) at the initial visit to the dermatology clinic, 1 week after treatment and 3 months after treatment. Lesions had been present for a mean of 25 months (range = 1-240 months), their mean diameter was 9.6mm (range = 3-35mm) and the sites were head and neck (79%), trunk (17%) and limbs (4%). There was no relationship between the quality of life score and size of lesion. Overall the scores at presentation were very low, rising 1 week after treatment and falling to below the initial scores at 3 months (mean UKSIP 0.4%, 0.7%, 0.13%; mean DLQI 5.3% 8.7%, 1.2%). BCCs cause little handicap. This may explain the delay in seeking medical attention and should be considered in planning public health education about BCCs.