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J Ali

Publications and source records attributed to J Ali.

At least 55 records · Page 3Linked to original sources
PubMed1997

Predictors of fetal mortality in pregnant trauma patients.

BACKGROUND: Fetal mortality after trauma is significant. This study was aimed at identifying factors responsible for this high fetal mortality. METHODS: All pregnant trauma patients admitted to the two major Toronto trauma institutions during the period of November of 1991 to February of 1996 with an Injury Severity Score (ISS) > or = 12 were assessed. Data on age, gestation, hypotension, ISS, hemoglobin, blood transfusion, length of stay, disseminated intravascular coagulation (DIC), and specific maternal injury were analyzed retrospectively to determine predictors of fetal mortality by comparison of patients with and without fetal survival. RESULTS: Twenty of a total of 68 pregnant trauma patients qualified for entry into the trauma registry by having an ISS > or = 12. Overall fetal mortality was 65% (13 of 20) for ISS > or = 12, and there was one maternal death (age, 29 years; ISS, 66). There were no statistically significant differences between the fetal death and fetal survival groups in age (29.2 +/- 6.2 vs. 30.4 +/- 3.9 years), gestation (25.3 +/- 10.5 vs. 24.1 +/- 9.2 weeks), lowest systolic blood pressure (98.3 +/- 33.8 vs. 112 +/- 18.0 mm Hg), head injury rate (3 of 13 vs. 1 of 7), extremity injury rate (8 of 13 vs. 2 of 7), abdominal injury rate (4 of 13 vs. 0 of 7), pelvic fracture rate (6 of 13 vs. 1 of 7), and chest injury rate (5 of 13 vs. 3 of 7). However, ISS (27.7 +/- 3.5 vs. 14.2 +/- 11.4), lowest hemoglobin level (78.8 +/- 17.0 vs. 101.9 +/- 17.1), blood transfusions (10.8 +/- 6.3 vs. 0.9 +/- 1.6 units), length of stay (20.9 +/- 16.7 vs. 8.2 +/- 4.9 days), and the incidence of DIC (8 of 13 vs. 0 of 7) were statistically significantly different between the two groups (p < 0.05). All eight patients with abruptio placentae had associated fetal mortality. CONCLUSIONS: Apart from ISS, blood loss, and abruptio placentae; the presence of DIC was the most significant predictor of fetal mortality. This finding may represent stimulation of DIC by placental products entering the maternal circulation after significant intrauterine injury.

Abruptio Placentae↗
PubMed1997

Effect of the prehospital trauma life support program (PHTLS) on prehospital trauma care.

BACKGROUND: Improvement in trauma patient outcome has been demonstrated after the implementation of the Prehospital Trauma Life Support (PHTLS) program in Trinidad and Tobago. This study was aimed at identifying prehospital care factors that may explain this improvement. METHODS: All patients transferred by ambulance to the major trauma referral hospital had assessment of airway control, oxygen use, cervical (C)-spine control, and hemorrhage control, as well as splinting of extremities during pre-PHTLS (July of 1990 to December of 1991; n = 332) and post-PHTLS periods (January of 1994 to June of 1995; n = 350). Pre-PHTLS data were compared with post-PHTLS data by chi 2 analysis with a p value < or = 0.05 being considered statistically significant. RESULTS: The frequency (%) increased in the post-PHTLS period for airway control (10 vs. 99.7%), C-spine control (2.1 vs. 89.4%), splinting of extremities (22 vs. 60.6%), hemorrhage control (16 vs. 96.9%), and oxygen use (6.6 vs. 89.5%) when no specific problem was identified. When a specific problem was identified in these areas, the post-PHTLS percentage also increased for airway control (16.2 vs. 100%), C-spine control (25 vs. 100%), splinting of extremities (33.9 vs. 100%), hemorrhage control (18 vs. 100%), and oxygen use (43.2 vs. 98.9%). CONCLUSIONS: Prehospital trauma care has changed after the introduction of the PHTLS program as indicated by more frequent airway control, use of oxygen, control of cervical (C)-spine and hemorrhage, as well as splinting of fractures. This finding was evident not only as a routine but particularly when a specific related problem was identified. This change in prehospital care could be responsible for the improved trauma patient outcome after PHTLS.

Adult↗
PubMed1997

Trauma patient outcome after the Prehospital Trauma Life Support program.

BACKGROUND: We have previously demonstrated a significant improvement in trauma patient outcome after the Advanced Trauma Life Support (ATLS) program in Trinidad and Tobago. In January of 1992, a Prehospital Trauma Life Support (PHTLS) program was also instituted. This study assessed trauma patient outcome after the PHTLS program. METHODS: Morbidity (length of stay and degree of disability), mortality, injury severity score, mechanism of injury, age, and sex among all adult trauma patients transported by ambulance to the major trauma hospital were assessed between July of 1990 to December of 1991 (pre-PHTLS, n = 332) and January of 1994 to June of 1995 (post-PHTLS, n = 350). RESULTS: Age, sex distribution, percentage blunt injury, and injury severity score were similar for both groups. Mortality pre-PHTLS (15.7%) was greater than post-PHTLS (10.6%). Length of stay and disability were statistically significantly decreased post-PHTLS. Age, injury severity score, and mechanism of injury were positively correlated with mortality in both periods. The previously reported post-ATLS mortality was similar to the pre-PHTLS mortality. CONCLUSIONS: Post-PHTLS mortality and morbidity were significantly decreased, suggesting a positive impact of the PHTLS program on trauma patient outcome.

Adult↗
PubMed1997

Vascular endothelial cadherin (VE-cadherin): cloning and role in endothelial cell-cell adhesion.

OBJECTIVE: To identify proteins responsible for intercellular junction integrity in human umbilical vein endothelial cells (HUVEC), we produced a monoclonal antibody that recognized an endothelial cell-specific, junctionally restricted protein. We characterized and cloned the antigen to study its functional properties. METHODS: The size and cellular distribution of the antigen were determined by immunofluorescence and immunoprecipitation. The molecule was cloned and transfected into cell lines, and its role in cell-cell adhesion and growth rate was determined. RESULTS: Monoclonal antibody hec1 recognizes VE-cadherin, an endothelial cell-restricted cell adhesion molecule. VE-cadherin is localized to the borders between apposing endothelial cells but is diffusely distributed on subconfluent or migrating cells. Transfection of fibroblasts with VE-cadherin imparts to them the ability to adhere to each other in a calcium-dependent homophilic manner. Expression of VE-cadherin over a several-log range does not change the growth rate of these cells. CONCLUSIONS: Despite the fact that VE-cadherin is a "nonclassical" cadherin by structure, it functions as a classic cadherin by imparting to cells the ability to adhere in a calcium-dependent, homophilic manner. On HUVEC it appears to play a role in maintaining monolayer integrity.

Animals↗
PubMed1997

Penetrating and blunt neck trauma: 10-year review of a Canadian experience.

OBJECTIVES: To determine if selective management of blunt and penetrating neck trauma is still appropriate in Canadian tertiary care centres because of differences in trauma demographics. A key secondary objective was a descriptive analysis of the Canadian head and neck trauma patient population and outcomes. DESIGN: A retrospective case series. SETTING: An academic tertiary care centre. PATIENTS: All 85 patients admitted between 1982 and 1992 with a diagnosis of blunt (19) or penetrating (66) neck trauma. INTERVENTIONS: Emergent neck explorations (29 patients), selective nonoperative management (20 patients) and elective neck exploration (17 patients). MAIN OUTCOME MEASURES: Hospital stay, complication rate, rate of negative exploration (elective management, emergent exploration) and rate of secondary exploration (selective management), and outcome and complication rate. The entire population was described demographically. RESULTS: In 66 patients the injuries were penetrating, with the majority being of low kinetic energy. The patients who underwent elective mandatory exploration were comparable to those who underwent selective nonoperative management. The length of stay in hospital for the selective group was significantly less (p = 0.0008), and no patient in this group required later operative management of a missed injury. However, 41% of patients who underwent elective mandatory neck exploration had no significant injury. The complication rate in the two groups was similar. CONCLUSIONS: The patients managed selectively had no difference in outcome from those who underwent mandatory elective exploration. In Canada, because of the lower incidence of high-morbidity zone I and zone III injuries and the high incidence of low kinetic energy trauma with a predilection to zone II, the surgeon may consider a selective approach where appropriate.

Adolescent↗
PubMed1997

Employment transitions and psychological distress: the contrasting experiences of single and married mothers.

This paper presents a longitudinal examination of the effect of employment transitions on the psychological distress of 398 single and 454 married mothers. Our analyses reveal that the effects of employment transitions differ for single and married mothers. Among women who left their jobs during the course of this study, we find a significant increase in distress among single mothers but no change in distress among married mothers. Transitions out of employment among single mothers produce increases in financial strain that result in declines in levels of self-esteem and mastery which, in turn, manifest themselves in higher levels of psychological distress. When we examine the effects of transitions into paid work, there are surprisingly few effects on mothers' levels of distress. For single mothers, taking a job for pay offers no significant reduction in their feelings of distress. Among married mothers, transitions into employment are associated with declines in distress, but these declines are offset by the distressful consequences of increases in caregiving strain. Thus, the effects of employment transitions on distress are a function of the differential impact of changes in stressors and psychosocial resources among single and married mothers as well as variations in the economic context and meanings of employment transitions. Movements into or out of employment do not offer the same opportunities and benefits or engender the same costs for single and married mothers. Our results also highlight the different policy implications that emerge from a consideration of longitudinal as opposed to cross-sectional analyses of these issues.

Adult↗
PubMed1996

Trauma ultrasound workshop improves physician detection of peritoneal and pericardial fluid.

Hemoperitoneum represents a major indication for surgical intervention after trauma. To improve the ability of surgical residents and trauma physicians to detect intraperitoneal and pericardial fluid using ultrasound as a diagnostic modality, we conducted a focused trauma ultrasound workshop consisting of discussion of ultrasound physics, demonstration of instrumentation, review of pertinent literature, videotaped demonstration, and "hands-on" teaching of the skills utilizing live patient models. The ultrasound probes were placed in four standard locations--right and left upper quadrants, epigastrium, and Pouch of Douglas. Skills acquisition was tested by pre- and postworkshop performance on 12 sonograms (3 for each location, 6 were positive for fluid). Thirty physicians (21 residents and 9 staff: Group I) who attended the workshop were compared to 30 matched controls (Group II). The results (means +/- SD) were as follows (R = number right, I = number of "indeterminate," W = number of wrong responses out of 12, *P < 0.05 compared to Group II): [Table: see text] False positive (%) and false negative (%) decreased from 12.9 +/- 1.5 to 8.9 +/- 5.3 and 15.0 +/- 10.4 to 5.0 +/- 5.2, respectively, in Group I but did not change in Group II. Postworkshop ability to detect fluid was significantly (P < 0.05) improved, with no major differences between residents and staff. Our data suggest that these workshops can significantly improve the skills of nonradiologists in sonographic identification of pericardial and intraperitoneal fluid and should therefore be considered an essential component of ultrasound training for trauma physicians.

Ascitic Fluid↗
PubMed1996

Teaching effectiveness of the advanced trauma life support program as demonstrated by an objective structured clinical examination for practicing physicians.

Although the Advanced Trauma Life Support (ATLS) course is now taught internationally, its teaching effectiveness still requires confirmation. The Objective Structured Clinical Examination (OSCE) reliably assesses clinical performance by utilizing standardized patients. An OSCE of eight 15 minute trauma patient stations and two 40 item MCQ tests were used to test the teaching effectiveness of the ATLS program in 32 practicing physicians who applied for an ATLS program in Trinidad and Tobago. The physicians were randomly assigned to an ATLS group (n = 16) that completed the ATLS course and a non-ATLS group (n = 16). Before and after the ATLS course, all physicians completed MCQ tests and trauma OSCE. Mean (+/- SD) OSCE scores (standardized to 20) ranged from 9.8 +/- 1.7 to 10.0 +/- 1.7 and 9.5 +/- 1.8 to 10.8 +/- 1.3 in the ATLS and non-ATLS groups, respectively, prior to the ATLS course (NS). Post-ATLS OSCE scores ranged from 15.9 +/- 1.7 to 17.6 +/- 1.7 in the ATLS group (p < 0.05 compared to pre-ATLS) and 9.5 +/- 1.4 to 10.1 +/- 1.3 in the non-ATLS group, which did not improve their OSCE scores. Adherence to priorities was graded 1 to 7 with the pre-ATLS grades of 1.7 +/- 0.6 (ATLS) and 1.8 +/- 0.7 (non-ATLS) and post-ATLS grades of 6.4 +/- 1.1 (ATLS) and 2.1 +/- 0.6 (non-ATLS). Organized approach to trauma was graded 1 to 5 with pre-ATLS grades of 1.6 +/- 0.5 (ATLS) and 1.7 +/- 0.6 (non-ATLS) and post-ATLS grades of 4.5 +/- 0.6 (ATLS) and 1.9 +/- 0.6 (non-ATLS). Pre-ATLS MCQ scores (%) were similar: 53.1 +/- 8.4 (ATLS) and 57.3 +/- 5.4 (non-ATLS), but post-ATLS scores were greater in the ATLS group: 85.8 +/- 7.1 (ATLS) and 64.2 +/- 3.6 (non-ATLS). Our data support the teaching effectiveness of the ATLS program among practicing physicians as measured by improvement in OSCE scores, adherence to trauma priorities, maintenance of an organized approach to trauma care, and cognitive performance in MCQ examinations.

Clinical Competence↗
PubMed1996

Attrition of cognitive and trauma management skills after the Advanced Trauma Life Support (ATLS) course.

OBJECTIVE: To test the attrition of cognitive and trauma management skills among practising physicians after the Advanced Trauma Life Support (ATLS) course. DESIGN, MATERIALS, AND METHODS: Sixty practising physicians who completed the ATLS course had comparative assessment of cognitive skills (with multiple choice questions, MCQ) pre-ATLS, immediately post-ATLS, at 6 months (group A), 2 years (group B), 4 years (group C), and 6 years (group D) after the course. Trauma management skills were also compared using eight Objective Structured Clinical Examination (OSCE) trauma stations completed by the four groups of physicians. MEASUREMENTS AND MAIN RESULTS: Pre-ATLS MCQ scores (54.2 +/- 4.2 to 59.8 +/- 5.3%) and immediately post-ATLS MCQ scores (85.9 +/- 5.1 to 87.7 +/- 5.3%) were similar in all four groups. Follow-up MCQ scores were 77.8 +/- 3.6% at 6 months 70.6. +/- 1.9% at 2 years, 69.4 +/- 1.7% at 4 years, and 68.9 +/- 2.0% at 6 years. OSCE scores out of a maximum of 20 were 16.8 +/- 0.3 at 6 months, 13.9 +/- 0.1 at 2 years, 12.0 +/- 0.1 at 4 years, and 11.9 +/- 0.1 at 6 years. Adherence-to-priorities scores (maximum, 7) were 6.6 +/- 0.2 at 6 months, 6.8 +/- 0.1 at 2 years, 6.6 +/- 0.1 at 4 years, and 6.6 +/- 0.1 at 6 years. Organized-approach scores (maximum, 5) were 4.8 +/- 0.1 at 6 months, 4.6 +/- 0.2 at 2 years, 4.7 +/- 0.2 at 4 years, and 4.6 +/- 0.2 at 6 years. Using the MCQ 80% pass mark criterion, at least 50% of physicians fail by 6 months and all fail this cognitive test thereafter. CONCLUSIONS: Whereas cognitive and trauma management skills decline after the ATLS, these skills are maintained at similar levels between 4 and 6 years after ATLS. A 50% failure rate occurs within 6 months and maximum attrition of cognitive skills occurs within 2 years of ATLS completion. Major principles of adherence to priorities and maintenance of an organized approach to trauma care are preserved for at least 6 years after ATLS.

Adult↗
PubMed1996

Role of the trauma-room chest x-ray film in assessing the patient with severe blunt traumatic injury.

OBJECTIVES: To examine the accuracy of standard trauma-room chest x-ray films in assessing blunt abdominal trauma and to determine the significance of missed injuries under these circumstances. DESIGN: A retrospective review. SETTING: A regional trauma unit in a tertiary-care institution. PATIENTS: Multiply injured trauma patients admitted between January 1988 and December 1990 who died within 24 hours of injury and in whom an autopsy was done. INTERVENTION: Standard radiography of the chest. MAIN OUTCOME MEASURES: Chest injuries diagnosed and recorded by the trauma room team from standard anteroposterior x-ray films compared with the findings at autopsy and with review of the films by a staff radiologist initially having no knowledge of the injuries and later, if injuries remained undetected, having knowledge of the autopsy findings. RESULTS: Thirty-seven patients met the study criteria, and their cases were reviewed. In 11 cases, significant injuries were noted at autopsy and not by the trauma-room team, and in 7 cases these injuries were also missed by the reviewing radiologist. Injuries missed by the team were: multiple rib fractures (11 cases), sternal fractures (3 cases), diaphragmatic tear (2 cases) and intimal aortic tear (1 case). In five cases, chest tubes were not inserted despite the presence (undiagnosed) of multiple rib fractures and need for intubation and positive-pressure ventilation. CONCLUSIONS: Significant blunt abdominal trauma, potentially requiring operative management or chest-tube insertion, may be missed on the initial anteroposterior chest x-ray film. Caution must therefore be exercised in interpreting these films in the trauma resuscitation room.

Abdominal Injuries↗
PubMed1996

Hepatotoxic effects of tuberculosis therapy. A practical approach to a tricky management problem.

Side effects of the most commonly used first-line antituberculosis drugs range from minor gastrointestinal symptoms to severe hepatotoxicity. If unrecognized, they can lead to increased morbidity and mortality as well as to higher healthcare costs. Side effects are most evident in patients with underlying compromise in hepatic function. Erratic treatment protocols not only promote secondary drug resistance but also offset all gains in tuberculosis control. Recognition of this problem, mandatory directly observed therapy, judicious standardized follow-up planning, and implementation of modified treatment protocols when needed may play a dominant role in treating and controlling tuberculosis and may also prevent the morbidity and mortality sometimes associated with tuberculosis treatment. In view of the changing epidemiology of tuberculosis and its global impact, the American Thoracic Society and the Centers for Disease Control and Prevention may need to look closely into the issues outlined here to develop a consensus and establish more specific guidelines.

Antibiotics, Antitubercular↗
PubMed1995

Fibroblast growth factor receptors 1 and 2 are differentially regulated in murine embryonal carcinoma cells and in response to fibroblast growth factor-4.

We have studied the expression of two of the receptors for fibroblast growth factors, FGFR-1 and FGFR-2, in response to ligand binding and in embryonal carcinoma (EC cells). Exposure of mouse fibroblasts to FGF-4 or FGF-2 results in a drastic downregulation of the mRNA levels for FGFR-2, while expression of FGFR-1 mRNA appears unaffected. Furthermore, FGF-4 transformed cells display low levels of FGFR-2 mRNA and these levels are significantly increased by treatment with anti FGF-4 neutralizing antibodies. In undifferentiated F9 EC cells, the levels of FGFR-2 mRNA are very low and increase substantially upon induction of differentiation. The levels of mRNA for FGFR-1 are again unaffected. To gain information on the regulation of expression of the gene encoding FGFR-2 (bek) we have cloned the FGFR-2 promoter region and used it to drive the expression of plasmids encoding the bacterial CAT enzyme. Transfection of these plasmids into FGF treated and untreated cells did not produce significant variation in CAT activity, suggesting that FGFR-2 downregulation in response to ligand binding occurs mainly by a post-transcriptional mechanism. In contrast, plasmids containing as little as 140 nt of the FGFR-2 promoter region were regulated in F9 cells, showing substantially higher expression in differentiated than in undifferentiated cells. It appears therefore that FGFR-2 expression in fibroblasts and EC cells is regulated by somewhat different mechanisms. In contrast, FGFR-1 expression does not vary substantially under the conditions shown to affect FGFR-2 expression. The implications of these findings are discussed.

Animals↗
PubMed1995

Intracytoplasmic sperm injection of mouse oocytes with 5 mM Ca2+ at different intervals.

The objective of this investigation was to determine whether intracytoplasmic sperm injection (ICSI) can be performed in the mouse. Metaphase II oocytes were obtained from F1 hybrid mice (C57BL x CBA) by i.p. injections of 10 IU pregnant mare's serum gonadotrophin (PMSG) and human chorionic gonadotrophin (HCG) administered 48 h apart. Oocytes with cumulus oophorus were retrieved 13-14 h post HCG. Cumulus was dispersed with 0.1% hyaluronidase. Mouse spermatozoa were obtained from the cauda epididymides of males of the same strain. The spermatozoa were processed by the standard swim-up procedure. The harvested spermatozoa were then incubated for 1.5 h to allow capacitation. Healthy oocytes were injected with 3-4 pl 5 mM Ca2+, followed by one live morphologically normal spermatozoon into the cytoplasm at intervals of 0, 0.5, 1, 2 and 3 h. The proportion of 2-cell embryos that developed from oocytes injected with Ca2+ and spermatozoa ranged between 29.5 and 36.5% in all groups, with no statistical difference between treatments. Chromosomal analysis showed that two-thirds of the ICSI-derived 2-cell embryos were diploid. The proportion of parthenogenetically activated embryos in the ICSI groups was similar to that in the control group (8-10%) which was injected with Ca2+ and polyvinyl pyrrolidone only. The proportion of blastocysts that developed in culture from the ICSI-derived 2-cell embryos was of the order of 36-42%. Some blastocysts were used for cell number counts. There was a significant increase in total and inner cell mass counts of blastocysts in which the spermatozoon was injected at 2 and 3 h following Ca2+.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Effectiveness of chest tube clamping in massive hemothorax.

OBJECTIVE: To test the effectiveness of chest tube clamping in massive hemothorax. DESIGN, MATERIALS AND METHODS: This was assessed in 32 spontaneously breathing Yorkshire piglets with 2.5 mm (groups A and B) or 4.0 mm (groups C and D) lacerations of the thoracic aorta. MEASUREMENTS: Hemodynamics, blood loss, length of survival, and arterial blood gases (on 100% oxygen) were monitored. The four groups of eight animals all had chest tubes but groups A and C had these tubes clamped. Measurements were made at baseline, immediately after aortic injury, and every 15 minutes until death. RESULTS: Groups C and D survived 39 +/- 4 and 38 +/- 5 minutes respectively compared to 68 +/- 6 and 70 +/- 4 minutes in groups A and B. Total blood loss was not statistically significantly different among the four groups (1225 +/- 72, 1312 +/- 84, 1020 +/- 90, and 1110 +/- 84 mL for groups A, B, C, and D respectively). The rate of blood loss was greater in groups C and D (29.4 +/- 0.2 mL and 30.1 +/- 0.3 mL/min) compared with 14.7 +/- 0.5 mL and 16.0 +/- 0.9 mL/min respectively in groups A and B. Blood loss rate was similar with clamped or unclamped chest tubes. All groups had similar baseline cardiac output (3.5 to 3.8 L/min) and arterial blood pressures (110 to 114 mm Hg) with a greater decrease in these parameters following the larger lacerations and no difference with chest tube clamping. Arterial PO2 decreased from approximately 400 to 50 mm Hg with clamping but only decreased to approximately 350 mm Hg without clamping. The hypoxia was associated with significant hypercapnea (PCO2 of 78 mm Hg). CONCLUSIONS: Chest tube clamping did not decrease hemorrhage or mortality but worsened gas exchange without improving hypotension and is therefore not recommended in the treatment of massive hemothorax.

Animals↗
PubMed1995

Fluid and electrolyte deficit with prolonged pneumatic antishock garment application.

OBJECTIVE: When trauma victims are within 1 hour of definitive surgical care, prehospital pneumatic antishock garment (PASG) application has not improved outcome. A resuscitative role for PASG has been suggested when transport time is longer (e.g., 4 hours). We assessed the fluid and electrolyte cost of treating posthemorrhagic hypotension with the PASG in 16 anesthetized Yorkshire piglets (30 to 32 kg). DESIGN: Hypotension [30 mm Hg drop in carotid arterial blood pressure (CBP)] was produced by arterial line bleeding. Hemodynamics, serum electrolytes, lactate, and tissue edema (limb circumference) were monitored. MATERIALS AND METHODS: In eight animals (group 1), PASG was inflated to maintain prebleed CBP for 4 hours. In group 2, the hypotension was untreated for 4 hours. After 4 hours, shed blood (over a period of 15 minutes) and normal saline (1.5 mL/kg/minute) were infused until CBP returned to normal baseline values. MEASUREMENTS AND MAIN RESULTS: Shed blood alone did not restore baseline CBP. Serum K+ increased from a baseline of 3.9 to 9.1 mmol/L in group 1, with no significant change in group 2. Serum lactate rose from 1.8 to 24.1 and from 1.7 to 6.8 mmol/L in groups 1 and 2, respectively. After 4 1/2 hours, an increase in thigh circumference (6.4 +/- 1.4 vs. 1.9 +/- 1.0 mm) and intravenous fluid required after returning shed blood (626 +/- 36 vs. 324 +/- 22 mL) was greater in group 1 (means +/- SD, p < 0.05). Other serum electrolyte values were similar for the two groups. CONCLUSIONS: We conclude that fluid deficit, lactic acidosis, tissue edema, and hyperkalemia are all greater with prolonged PASG application when compared with the untreated hypotensive state. These findings must be considered when suggesting more prolonged PASG application.

Animals↗
PubMed1995

Pulmonary function and posture in traumatic quadriplegia.

OBJECTIVE: To determine optimum posture for pulmonary function in traumatic quadriplegia. DESIGN: Lung function with changes in posture of normal healthy volunteers was compared with that of traumatic quadriplegic patients. MATERIALS AND METHODS: Functional residual capacity (FRC), Forced vital capacity (FVC), and arterial blood gases in room air were compared in 16 male patients aged 18 to 32 years, 8 of whom (group I) sustained traumatic quadriplegia (C6 to C7) at least 1 year previously, and 8 of whom (group II) were healthy volunteers. MEASUREMENTS: FRC, FVC and blood gases were measured after 15 minutes in the following random positions: 20 degrees head down, horizontal, 35 degrees head up, 60 degrees head up, and 90 degrees head up. MAIN RESULTS: FRC was lower in all positions in group I but there was a similar directional change in FRC with posture in both groups. The greatest increase in FRC occurred in group I between the 35-degree head up and the 60-degree head up positions. Group I, in contrast to group II, decreased FVC from the 35-degree head up to the 60-degree head up position. There were no significant changes in PO2 with position in group II, but quadriplegic patients showed PO2 improvement from the head down to the horizontal and 60-degree head up positions. CONCLUSIONS: In traumatic quadriplegia, maximum oxygenation and patency of alveoli (FRC) are achieved in the 60- to 90-degree head up positions. In contrast to normal subjects, no changes in FRC and FVC occurred between the horizontal and 35-degree head up positions in quadriplegia. The optimum position in these patients for physiotherapy (deep breathing and coughing, as reflected by maximum FVC) is the horizontal or 35-degree head up position. These differences in lung volumes and oxygenation with posture may be important in optimizing respiratory care in traumatic quadriplegia.

Adult↗
PubMed1994

Advanced trauma life support program increases emergency room application of trauma resuscitative procedures in a developing country.

Over a 9-year period (July 1981-December 1985--pre-ATLS period; January 1986-June 1990--post-ATLS period), the hospital charts of 813 trauma patients with ISS > or = 16 were reviewed (n = 413, pre-ATLS and n = 400, post-ATLS) in order to assess the impact of the ATLS program. The frequency of endotracheal intubation (ET), nasogastric tube insertion (NG), intravenous access (i.v.), Foley catheterization of the bladder (Foley) and chest tube insertion (CT) were compared by Pearson Chi-square analysis. Overall, pre-ATLS vs. post-ATLS frequencies (%) were 83.5 vs. 65.3 for ET, 97.3 vs. 98.0 for i.v., 74.6 vs. 96.3 for Foley, 68.3 vs. 91.3 for NG, and 18.4 vs. 47.0 for CT. In the emergency room these frequencies (%) were 26.1 vs. 36.4 for ET, 98.8 vs. 98.7 for i.v., 11.0 vs. 97.1 for Foley, 3.2 vs. 95.9 for NG, and 3.9 vs. 95.2 for CT. The differences in the application of these life saving procedures between the pre-ATLS and post-ATLS periods were statistically significant (p < 0.05) except i.v. access, which showed no difference between the pre-ATLS and post-ATLS groups. Of the patients with severe chest injuries (AIS > or = 3) 87.7% had chest tubes post ATLS (94.4% in ER) compared with 48.1% pre ATLS (3.2% in ER). These differences were associated with significant improvement in trauma patient outcome post ATLS. We conclude that the frequency of lifesaving interventions, particularly in the ER, was increased post ATLS.(ABSTRACT TRUNCATED AT 250 WORDS)

Catheterization, Peripheral↗