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Biomedical subjects

D E Wesson

Publications and source records attributed to D E Wesson.

At least 37 records · Page 2Linked to original sources
PubMed1998

Dietary acid increases blood and renal cortical acid content in rats.

We examined whether dietary acid that increases net acid excretion (NAE) without measurably decreasing plasma pH or total CO2 (tCO2) causes net acid retention. Control rats drinking distilled H2O were compared with those drinking 40 mM (NH4)2SO4, 40 mM Na2SO4, or drinking Na2SO4 and given aldosterone (Na2SO4 + Aldo) to increase NAE without dietary acid. Systemic plasma tCO2 increased in Na2SO4 + Aldo animals, but systemic and stellate vessel plasma tCO2 and pH were not different from control among remaining groups. NAE increased in (NH4)2SO4 and Na2SO4 + Aldo but not in Na2SO4 animals. Blood base excess (BBE) decreased compared with its respective baseline in (NH4)2SO4 (-0.44 +/- 0.06 vs. 0.66 +/- 0.04 mumol/ml; P < 0.01, paired t-test), increased in Na2SO4 + Aldo (0.79 +/- 0.05 vs. 0.61 +/- 0.03 mumol/ml; P < 0.04, paired t-test), but was unchanged in Na2SO4 animals. Renal cortical H+ content assessed by microdialysis of the renal cortex in situ increased in (NH4)2SO4, decreased in Na2SO4 + Aldo, but was unchanged in Na2SO4 animals. The data show that dietary acid sufficient to increase NAE without decreasing plasma tCO2 or pH nevertheless decreases BBE and increases renal cortical acid content, consistent with net acid retention.

Acid-Base Equilibrium↗
PubMed1997

Endogenous endothelins mediate increased distal tubule acidification induced by dietary acid in rats.

We examined if endogenous endothelins mediate the decreased HCO3 secretion and increased H+ secretion in in vivo-perfused distal tubules of rats fed dietary acid as (NH4)2SO4. Animals given (NH4)2SO4 drinking solution had higher endothelin-1 addition to renal interstitial fluid than those given distilled H2O (480+/-51 vs. 293+/-32 fmol g kidney wt(-1) min(-1), respectively, P < 0.03). (NH4)2SO4-ingesting animals infused with bosentan (10 mg/kg) to inhibit A- and B-type endothelin receptors had higher HCO3 secretion than baseline (NH4)2SO4 animals (-4.7+/-0.4 vs. -2.4+/-0.3 pmol mm(-1) min(-1), P < 0.01), but (NH4)2SO4 animals given a specific inhibitor of A-type endothelin receptors (BQ-123) did not (-2.0+/-0.2 pmol mm(-1) min(-1), P = NS vs. baseline). H+ secretion was lower in bosentan-infused compared with baseline (NH4)2SO4 animals (27.7+/-2.5 vs. 43.9+/-4.0 pmol mm(-1) min(-1), P < 0.03), but that for BQ-123-infused (NH4)2SO4 animals was not (42.9+/-4.2 pmol mm(-1) min(-1), P = NS vs. baseline). Bosentan had no effect on distal tubule HCO3 or H+ secretion in control animals. The data show that dietary acid increases endothelin-1 addition to renal interstitial fluid and that inhibition of B- but not A-type endothelin receptors blunts the decreased HCO3 secretion and increased H+ secretion in the distal tubule of animals given dietary acid. The data are consistent with endogenous endothelins as mediators of increased distal tubule acidification induced by dietary acid.

Acidosis, Renal Tubular↗
PubMed1997

Esophageal atresia and tracheoesophageal fistula: surgical experience over two decades.

BACKGROUND: Despite improvements in survival, for infants born with esophageal atresia tracheoesophageal fistula, or both, the morbidity associated with repair of these anomalies remains high. METHODS: This report retrospectively analyzes 81 patients with esophageal atresia, tracheoesophageal fistula, or both presenting to our institution between 1975 and 1995, with a focus on anastomotic complications. RESULTS: There were 46 male and 35 female patients with a mean gestational age of 37 weeks and mean birth weight of 2443 g. Forty-four patients underwent primary esophageal anastomoses, 7 underwent delayed primary anastomoses, 12 patients underwent staged repairs, and 5 underwent repair of H-type fistulas. Among 62 patients with anastomoses, complications included stricture in 25/62 patients (40%), leakage in 12/62 patients (19%), and recurrent tracheoesophageal fistulas in 6/62 patients (10%). Stricture rates for esophagoclonic anastomoses versus esophagoesophageal anastomoses were 4/8 cases (50%) versus 21/54 cases (39%). This difference was not statistically significant. All esophagoesophageal strictures were managed successfully with dilations; three of four esophagocolonic strictures required anastomotic revision. The leakage rate for esophagocolonic anastomoses versus esophagoesophageal anastomoses was 6/8 cases (75%) versus 6/54 cases (11%). This difference was statistically significant (p = 0.0003). Two patients required revision of their colon grafts secondary to necrosis. Eighteen of 81 patients (22%) died. Operative mortality was 9/74 (12%). Causes of death included associated anomalies (n = 15), recurrent aspiration and sepsis secondary to missed fistula (n = 1), and unknown (n = 2). CONCLUSIONS: Although the morbidity associated with surgical repair of these anomalies is high, this does not affect the overall survival. The high complication rate associated with colonic interposition suggests that one should preserve the native esophagus as a primary conduit whenever feasible.

Anastomosis, Surgical↗
PubMed1997

Endothelin-1 increases rat distal tubule acidification in vivo.

Because endothelin receptor inhibition blunts increased distal tubule acidification induced by dietary acid, we examined whether endothelin-1 (ET-1) increases acidification of in vivo perfused distal tubules of anesthetized rats. ET-1 was infused intraaortically (1.4 pmol x kg(-1) x min[-1]) into control animals and into those with increased distal tubule HCO3 secretion induced by drinking 80 mM NaHCO3 solution for 7-10 days. ET-1 increased distal tubule acidification in both control and NaHCO3 animals. Increased acidification in control animals was mediated by increased distal tubule H+ secretion (23.7+/-2.2 vs. 18.7 +/- 1.7 pmol x mm(-1) x min(-1), P < 0.05) with no changes in HCO3 secretion. By contrast, ET-1 increased distal tubule acidification in NaHCO3 animals predominantly by decreasing HCO3 secretion (-9.5 +/- 1.0 vs. -18.7 +/-1.8 pmol x mm(-1) x min(-1), P < 0.001) with less influence on H+ secretion. When indomethacin was infused (83 microg x kg(-1) x min[-1]) to inhibit synthesis of prostacyclin, an agent previously shown to increase HCO3 secretion in the distal tubule, ET-1 increased distal tubule H+ secretion in both control (24.3 +/-2.2 vs. 15.7 +/- 1.6 pmol x mm(-1) x min(-1), P < 0.02) and NaHCO3 (20.0 +/- 2.0 vs. 13.6 +/- 1.4 pmol x mm(-1) x min(-1), P < 0.05) without affecting HCO3 secretion. The data show that ET-1 increases distal tubule acidification in vivo and can do so by increasing H+ secretion and by decreasing HCO3 secretion when the latter is augmented by dietary NaHCO3.

Acids↗
PubMed1996

Blunt cardiac injuries in children: a postmortem study.

We reviewed the records of the Chief Coroner for all pediatric (< 16 years of age) trauma fatalities in Ontario (pediatric population of 2 million) for the period January 1, 1988 through December 31, 1990. Forty-one (14.5%) of 282 patients for which complete autopsy data were available had sustained cardiac injuries. Nineteen patients (46%) died at the scene of the accident, 15 patients (37%) died in an emergency department, and seven patients (17%) died during hospitalization. Rupture of a cardiac chamber occurred in 16 cases; it was the main cause of death in eight cases and a contributing factor in the remainder. Cardiac contusion without chamber rupture was present in 25 cases, but in none of the cases was it the cause of death. Brain injury was the cause of death in 16 (64%) of the cases of cardiac contusion. Cardiac injuries are more common among children who die from blunt trauma than previous reports have suggested. However, because these injuries are often rapidly fatal, many patients die before they reach a hospital. With improvements in emergency medical services and the resulting reduction in transit time, more patients may reach trauma centers alive. A high index of suspicion and rapid diagnosis and treatment of these injuries can save the lives of some of these patients.

Adolescent↗
PubMed1996

Dietary HCO3 reduces distal tubule acidification by increasing cellular HCO3 secretion.

We examined the components of net HCO3 reabsorption (H+/HCO3 secretion and transepithelial HCO3 permeability) in in vivo perfused distal tubules of anesthetized rats to determine the mechanisms by which dietary HCO3 reduces acidification in this nephron segment. Animals eating a minimum electrolyte diet drank either (in mM) 80 NaHCO3, 80 NaCl, or 40 Na2SO4 for 7-10 days and were compared with controls drinking distilled H2O. On perfusion with a HCO3- and Cl- -containing solution, net HCO3 reabsorption was lower than control in only the NaHCO3 animals (14.4 +/- 1.3 vs. 4.1 +/- 0.5 pmol.mm-1.min-1, P < 0.001). On perfusion with a 0 HCO3-0 Cl- solution, distal tubule luminal HCO3 accumulation (JHCO3) was higher in NaHCO3 animals than control (-13.7 +/- 1.3 vs. -4.7 +/- 0.7 pmol.mm-1.min-1, P < 0.002). Despite a higher JHCO3, estimated transepithelial HCO3 permeability in the NaHCO3 animals was similar to control [0.52 +/- 0.06 vs. 0.36 +/- 0.04 x 10(-7) cm2/s, P = not significant (NS)]. Luminal acetazolamide (Az) reduced JHCO3 in NaHCO3 animals to a level similar to control (-6.2 +/- 0.6 vs. -4.0 +/- 0.5 pmol.mm-1.min-1, P = NS) in this nephron segment containing cells with cytoplasmic but no luminal carbonic anhydrase activity. Including Cl- in the initial perfusate increased JHCO3 in NaHCO3 animals only (-20.8 +/- 1.9 vs. -13.7 +/- 1.3 pmol.mm-1.min-1, P < 0.02), and this increase was inhibited by luminal Az. Calculated H+ secretion was similar among groups. Together, the data indicate that dietary HCO3 reduces distal tubule acidification by increasing Az-sensitive generation of HCO3 by distal tubule cells that enters the lumen by a mechanism augmented by luminal Cl-.

Absorption↗
PubMed1996

Reduced bicarbonate secretion mediates increased distal tubule acidification induced by dietary acid.

We examined the components of net HCO3 reabsorption (H+/HCO3 secretion) in in vivo perfused distal tubules of anesthetized rats to determine the mechanisms by which dietary acid increases acidification in this nephron segment. Animals eating a minimum electrolyte diet drank either 80 mM NH4Cl or 40 mM (NH4)2SO4 for 7-10 days and were compared with controls drinking distilled H2O. Net HCO3 reabsorption in distal tubules perfused with HCO3 concentration ([HCO3]) similar to that in situ (5 mM) was higher in (NH4)2SO4 animals than in control (21.6 +/- 1.8 vs. 12.5 +/- 1.3 pmol.mm-1.min-1, respectively, P < 0.02), but that for NH4Cl (17.9 +/- 1.5 pmol.mm-1.min-1, P = 0.09 vs. control) animals was not. Calculated H+ secretion was not different among groups perfused with the 5 mM HCO3 solution, but calculated HCO3 secretion was lower in (NH4)2SO4 animals than control (-2.4 +/- 0.3 vs. -5.3 +/- 0.6 pmol.mm-1.min-1, respectively, P < 0.02), but that for NH4Cl (-7.2 +/- 0.7 pmol.mm-1.min-1, P = not significant vs. control) was not. When distal tubules were perfused with solutions containing higher [HCO3] (10 nM), both net HCO3 reabsorption and calculated H+ secretion were significantly higher than control in both acid-ingesting groups. The data show that reduced HCO3 secretion mediates the increased distal tubule acidification induced by dietary acid, particularly at the low tubule fluid [HCO3] in situ. The data also show that acid ingested as the Cl- compared with the SO4(-) salt does not reduce HCO3 secretion and less effectively increases acidification in this nephron segment.

Absorption↗
PubMed1996

Prostacyclin increases distal tubule HCO3 secretion in the rat.

We examined whether prostacyclin (PGI2), a prostaglandin synthesized in the renal cortex that increases adenosine 3',5'-cyclic monophosphate levels in distal nephron epithelia, mediates increased HCO3 secretion in in vivo perfused distal tubules of anesthetized rats given dietary HCO3. Animals eating a minimum electrolyte diet given 80 mM NaHCO3 drinking solution increased urine excretion of 6-keto-PGF1 alpha, a PGI2 metabolite, by 2.6 +/- 0.3-fold compared with those drinking distilled H2O. NaHCO3 animals infused with indomethacin to inhibit PGI2 synthesis had lower HCO3 secretion than those without indomethacin (-8.9 +/- 0.9 vs. -18.7 +/- 1.8 pmol.mm-1.min-1, P < 0.01). By contrast, NaHCO3 animals infused with both PGI2 and indomethacin had higher HCO3 secretion than those given indomethacin alone (-16.0 +/- 1.5, P < 0.02 vs. indomethacin group). HCO3 secretion was not different between controls with and without indomethacin but was higher in the PGI2 + indomethacin compared with the indomethacin alone controls (-11.2 +/- 1.2 vs. -4.5 +/- 0.5, P < 0.01). The data show that PGI2 increases distal tubule HCO3 secretion in rats and suggest that this agent contributes to the increased distal tubule HCO3 secretion induced by dietary HCO3.

Animals↗
PubMed1996

A symptomatic atypical mycobacterial infection masquerading as a vascular ring on chest x-ray.

Atypical mycobacterium is rare in children. There are few case reports of childhood pulmonary diseases caused by atypical mycobacterium. The case of a 20-month-old boy who had stridor and respiratory distress is presented. Chest x-ray showed right-sided narrowing of the trachea and left-sided aortic knob. Ziehl-Neelsen stain showed acid-fast bacilli. The culture showed Mycobacterium malmoense.

Angiography↗
PubMed1996

Role of dietary factors in the hypertension of African Americans.

Epidemiological and experimental data suggest that dietary constituents are among the causative factors that contribute to the higher prevalence and severity of hypertension in African Americans as compared with European Americans. Given the difficulty of cleanly separating a change in one dietary nutrient from concomitant changes in others, it has been difficult to reliably attribute an observed effect on blood pressure level and hypertension prevalence to the specific dietary constituent under study. Nevertheless, because hypertension is virtually nonexistent in societies whose dietary sodium chloride intake is very low, it appears that a sodium chloride intake in excess of that required to maintain adequate extracellular fluid volume is necessary but not sufficient for hypertension to be manifest. Additional factors are clearly necessary in the development of hypertension because most individuals, including African Americans, can ingest a high sodium chloride diet without developing hypertension. Evidence for the potential importance of other dietary constituents is also discussed, as are dietary strategies that effectively reduce blood pressure in hypertensive individuals. The data presented support the need for continued research into dietary constituents as potential factors contributing to the etiology of hypertension, as well as effective adjuncts to the management of this very common health problem.

Black or African American↗
PubMed1996

A pancreatic cyst of the anterior mediastinum.

Although heterotopia of pancreatic tissue is a developmental anomaly found in approximately 2% of all autopsies, pancreatic tissue within the thorax and mediastinum is uncommon. In most of these instances, the pancreatic acini and islets are components of gastroenteric duplication cysts, intralobar pulmonary sequestrations, or teratomas. We describe the clinicopathologic features and hormonal profile of a patient with an anterior mediastinal cyst formed entirely by pancreatic tissue. To our knowledge, the English literature reveals only two previous examples of this lesion. The patient, a previously healthy 16-year-old girl, was found to have a cystic lesion in the anterior mediastinum during investigation of an asymptomatic heart murmur. The lesion measured 12 cm in maximal diameter and contained dark, turbid fluid. The wall was fibrotic and contained a haphazard mixture of ducts, exocrine acini, and islets. In many areas, the ducts and islets formed ductuloinsular complexes resembling those seen in diffuse nesidioblastosis. Immunohistochemical examination showed that the islets contained an increased number of B and PP cells, recapitulating the hormonal profile of the ventral anlage of the fetal pancreas. The similarity between this lesion and a fetal pancreas was further supported by the presence of a significant number of islet cells containing gastrin. The histogenesis of this lesion is unclear; we think that this lesion represents a derivative of the ventral (anterior) primitive foregut, but unidirectional differentiation of a benign cystic teratoma cannot be excluded.

Adolescent↗
PubMed1996

Regulation of endoplasmic reticulum-Ca-ATPase by glycolysis in eukaryotic cells.

This paper reviews work by our and other laboratories that explores the coupling between glycolysis and endoplasmic reticulum (ER)-Ca-ATPases in regulating Ca2+ homeostasis in several cell types. Changes in intracellular Ca2+ [(Ca2+]in) link interaction between hormones and cell surface receptors with the initiation of specific cellular functions. Thus, changes in [Ca2+]in mediate signal transduction mechanisms that modulate many physiological functions including cell growth, muscle cell contractility, and exocytosis in secretory cells. In most eukaryotic cells, total cellular Ca2+ is in the millimolar range, yet only a fraction (i.e., nanomolar) is free in the cytosol. Cells use both active and 'passive' mechanisms to maintain [Ca2+]in within a narrow range. Active mechanisms include plasma membrane and endoplasmic/sarcoplasmic reticulum (ER/SR)-Ca-ATPases, Ca2+ channels (inositol trisphosphate- and voltage-sensitive), and Na+/Ca2+ exchangers. 'Passive' mechanisms include Ca(2+)-binding proteins (e.g., calsequestrin, calmodulin, calreticulin). The relative contribution of active and 'passive' mechanisms to [Ca2+]in homeostasis in a given cell is not known. Ca2+ might move among several intracellular compartments, including the ER/SR, mitochondria, nucleus, Golgi apparatus, endosomes and lysosomes. The ubiquitous distribution of ER-Ca-ATPases in these intracellular organelles suggests a major role of this pump in Ca2+ homeostasis, but the importance of intracellular compartments to [Ca2+]in homeostasis is not well understood. Glucose has been suggested to have a role in regulating some of these ion transport processes. Thus, the increased cell metabolism that follows glucose stimulation is associated with altered [Ca2+]in homeostasis. The precise mechanisms by which glucose or its metabolites modulate [Ca2+]in homeostasis are unknown but might involve regulation of ER-Ca-ATPases.

Calcium↗
PubMed1995

Bicycling exposure and severe injuries in school-age children. A population-based study.

OBJECTIVES: To examine exposure to bicycling and its association with severe bicycle injuries in school-age children in a defined population. DESIGN: Random-digit dialing telephone survey and analysis of hospital discharge records. SETTING: Metropolitan Toronto, Ontario. SUBJECTS: Sample of parents of children aged 5 to 17 years who owned a bicycle; all children who were admitted to hospitals with bicycle-related injuries from April 1989 to March 1991. MAIN OUTCOMES: Median annual bicycling hours and distance by age and sex; age- and sex-specific incidence rates by population at risk, cumulative exposure hours, and riding distances. RESULTS: More than half of the children of all age groups were exposed to bicycling more than 100 hours per year. Boys spent more hours and rode longer distances than girls in every age group. The overall annual injury rates were 8.1 and 3.4 per 10,000 population at risk for boys and girls, respectively. About half of the injuries suffered were head injuries. When rates were estimated on the basis of exposure, boys still experienced a higher injury rate than girls. Boys displayed a slight increase with age in rates per unit of exposure hours. Conversely, age appeared to be negatively associated with overall and head injury rates when exposure was expressed by distance ridden. CONCLUSIONS: Boys had a higher injury rate than girls, and bicycle-related injuries are more likely to be associated with exposure time than distance ridden.

Adolescent↗
PubMed1995

The H2O2-generating enzyme, xanthine oxidase, decreases luminal Ca2+ content of the IP3-sensitive Ca2+ store in vascular endothelial cells.

OBJECTIVE: Xanthine oxidase inhibits agonist-stimulated Ca2+ signaling in calf pulmonary artery endothelial cells by an H2O2-dependent mechanism. We investigated the effect of xanthine oxidase on luminal Ca2+ content of the inositol-1,4,5-trisphosphate (IP3)-sensitive Ca2+ store. METHODS: Luminal Ca2+ content was estimated from the net release of Ca2+ activated by 2,5-di-t-butylhydroquinone (BHQ), an inhibitor of microsomal Ca2+ pumps. RESULTS: Initially, xanthine oxidase depleted the IP3-sensitive Ca2+ store of releasable Ca2+, but with more prolonged incubation, the enzyme also depleted non-IP3-sensitive stores. In addition, xanthine oxidase inhibited capacitative Ca2+ influx. Similar results were observed when thapsigargin was substituted for BHQ. CONCLUSIONS: Depletion of luminal Ca2+ content within the IP3-sensitive Ca2+ store contributes to xanthine oxidase inhibition of Ca2+ signaling in vascular endothelial cells.

Animals↗
PubMed1995

Evaluation of a subsidy program to increase bicycle helmet use by children of low-income families.

OBJECTIVE: We have previously shown that an educational program was not effective in increasing bicycle helmet use in children of low-income families. The objective of this study was to evaluate a combined educational and helmet subsidy program in the same population, while controlling for secular trends. The secondary objective was to complete a third year of surveying children's bicycle helmet use throughout the study community. DESIGN: A prospective, controlled, before-and-after study. SUBJECTS: Bicycling children 5 to 14 years of age from areas of low average family income. SETTING: A defined geographic community within a large urban Canadian city. INTERVENTION: In April 1992, students in three schools located in the area of lowest average family income were offered $10 helmets and an educational program; three other low-income areas served as control areas. MAIN OUTCOME MEASURE: Helmet use was determined by direct observation of more than 1800 bicycling children. RESULTS: Nine hundred ten helmets were sold to a school population of 1415 (64%). Reported helmet ownership increased from 10% to 47%. However, observed helmet use in the low-income intervention area was no different from the rate in the three low-income control areas (18% versus 19%). There was no difference in the trend in helmet use during the period of 1990 through 1992 in the intervention area (4% to 18%) compared with the control areas (3% to 19%). Helmet use rates from all income areas have increased from 3.4% in 1990, to 16% in 1991, to 28% in 1992. In 1992, helmet use in the high-income areas was 48% and in the low-income areas was 20%. CONCLUSIONS: There has been a trend toward increasing helmet use in all income areas during the 3-year period. Despite encouraging helmet sales and increases in reported helmet ownership, the results of the observational study do not support the efficacy of a helmet subsidy program in increasing helmet use in children residing in areas of low average family income. Strategies to increase helmet use in children of low average family income remain a priority.

Adolescent↗
PubMed1995

Vascular relaxation probably mediates the antihypertensive effect of a high-potassium diet: a role for enhanced vascular Na,K-ATPase activity.

OBJECTIVE: to evaluate the effect of dietary potassium on blood pressure and vascular contractility in adult rats of two strains, spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto (WKY) rats. DESIGN: 'Potassium-induced relaxation' was evaluated in aortic rings as a functional measure of Na,K-ATPase activity in the vascular wall. The rats were fed one of three diets: regular (American Institute of Nutrition-76 rat chow); high-sodium (7% sodium chloride) or high-sodium plus potassium (7% sodium chloride and 13.4% potassium citrate) for 12 +/- 1 weeks. RESULTS: SHR fed the high-sodium diet had a mean blood pressure of 157 +/- 8 mmHg, as compared with 130 +/- 9 mmHg for those on a regular diet (P < 0.01). SHR fed the potassium-supplemented diet had a blood pressure of 122 +/- 9 mmHg (P < 0.01 versus the high-sodium diet group). The mean blood pressure of WKY rats was 78 +/- 3 mmHg and did not differ among the dietary groups. The 'potassium-induced relaxation' response of aortic rings from SHR and WKY rats fed a potassium-supplemented diet was significantly higher (P < 0.05) than that in animals in the corresponding high-sodium dietary group. This observation in potassium-supplemented rats is interpreted as indicative of increased Na,K-ATPase activity in the vascular wall. CONCLUSIONS: A potassium-rich diet in SHR receiving a high sodium intake was associated with lower blood pressure and higher vascular Na,K-ATPase activity. A similar effect of this diet on vascular Na,K-ATPase was observed in WKY. We propose that the antihypertensive effect of a potassium-rich diet is mediated, at least in part, by stimulation of vascular Na,K-ATPase activity.

Animals↗
PubMed1994

Functional limitations and recovery in children with severe trauma: a one-year follow-up.

To examine functional limitations, recovery rates, and association with Injury Severity Scores (ISSs), we followed 92 children with severe trauma and 59 control subjects with appendicitis at 6 months and 1 year after discharge. Physical health status was assessed by the Rand Health Insurance Study instrument. Overall, 73% and 55% of trauma patients had one or more functional limitations at 6 months and 1 year, respectively, in contrast to 14% and 9% of the controls. Overall functional status of the trauma patients improved by 22% in the first 6 months and 24% in the second. Much higher recovery rates (73% and 46%) were noted for self care. Although ISS did not correlate with overall functional status, higher ISSs were related to impairment in patients whose principal injury was to the head or the face-chest-abdomen but not in those whose principal injury was to an extremity. This study shows that many children with severe trauma are left with disabilities. Recovery rates are not uniform but depend on type of limitation. Functional impairment and recovery are related more to the body parts involved than to ISS.

Activities of Daily Living↗