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PubMed2004

Evaluation of residential exposure to intermediate frequency magnetic fields.

The authors measured the exposure to intermediate-frequency (IF: 10 kHz to 30 MHz) electromagnetic fields (EMF) in residential environments. They developed a system to acquire and record waveforms of IF magnetic fields (MFs) and set 5 nanotesla (nT) for the trigger level of acquisition. They operated the system near power lines, railroads, and electrical appliances as possible sources of IF-MFs. Most of the maximum values of magnetic flux density and the time derivative for each wave were below the upper limit of the measurable range of our system (i.e., 53 nT and 10 T/s); these values were much lower than the minimum amplitudes that can theoretically induce heating or membrane excitation within biological systems. Moreover, the amplitudes of the IF-MFs were not related to those of extremely low frequency (ELF) MF measured simultaneously, indicating that IF-MFs do not underlie the associations, observed in several epidemiological studies, between residential exposure to ELF-EMF and childhood cancer.

Electric Power Supplies↗
PubMedDate not supplied

Asbestos fiber analysis in nine lung cancer cases with high asbestos exposure.

We examined the types and sizes of 100 asbestos fibers in lung tissue obtained from 9 lung-cancer cases (5 autopsy and 4 surgical) with more than 10(4) asbestos bodies per 5 g of wet lung tissue, asbestos bodies in histological sections, and the history of occupational asbestos exposure. Evaluation of asbestos fibers by transmission electron microscopy (2,000 x magnification) revealed that most fibers were longer than 3 microns (96%) and were thicker than 0.1 micron (93%). The analytical conditions we used enabled us to identify 99.7% of all asbestos fibers as being amphibole asbestos. Crocidolite fiber, which was found most frequently (73.1%), was the predominant type of fiber found in 8 of the 9 cases; crocidolite was followed by amosite (21.7%), which was the predominant type found in the remaining case. Crocidolite fibers were thin and had a high aspect ratio (mean diameter = 0.23 micron, mean aspect ratio [length/diameter] = 85.5). Amosite fibers were long, and they also had a high aspect ratio (mean length = 21.8 microns, mean aspect ratio = 66.4). It has been suggested that such fibers with a high aspect ratio are strongly carcinogenic to pulmonary parenchyma. Review of our previous and present data with respect to the ratio of amosite to crocidolite fibers in groups of subjects who had various diseases revealed that this ratio was relatively constant in some occupations. The more predominant fibers found were crocidolite in insulation workers and amosite in railroad workers. The ratio of amosite to crocidolite fibers should be considered in tissue-burden studies.

Adult↗
PubMedDate not supplied

Stromal elements for tumor diagnosis: a brief review of diagnostic electron microscopic features.

Tumor diagnosis mainly depends on the appearance of the tumor cells in recapitulating the appearance of primordial cells from which they arise. However, certain tumors may present with specific stromal changes that may assist/enhance the diagnosis. In this presentation, diagnostic stromal features have been reviewed. The cytoplasm is enclosed by a unit membrane, which serves as a barrier to, as well as an interface with, surrounding structures. Epithelial cells usually show characteristic basal-apical orientation. In mesenchymal tissue, different types of interface can be found in different types of mesenchymal tissue. External lamina can be defined as an anatomic structure, which encloses anatomic functional units. In epithelial tissue, cells in a functional unit are enclosed within a well-defined external lamina (EL). In malignant epithelial tumors, EL can become increasingly indistinct as tumors become less differentiated, and one has to look for it diligently. Within the external lamina, epithelial cells are closely packed with closely apposed cell membranes and cell attachment junctions. In contrast to epithelial tissue, mesenchymal tissue is usually characterized by the stromal elements they produce. Individual cells are embedded in the stroma, and individual mesenchymal cells represent the functional unit. Vascular endothelial cells are an exception since their relationship to stroma resembles to that of epithelial cells. Thus, tumors deriving from mesenchymal cells known to have external lamina such as muscle cells and Schwann cells tend to show total enclosure of cells by external lamina. In malignant muscle tumors, external lamina production can be focally present and found only by diligent search. In Schwann cell tumors, the presence of EL is prominent in low-grade tumors and more irregular and variable in malignant tumors. In the latter, stromal aggregation of scrolls of external lamina can be characteristic. Similar features are seen in ossifying fibromyxoid tumors. Fibronexus junctions (composed of extracellular fibronectin fillements linking intracellular 5-nm filaments) is claimed to be typical of myofbroblasts. Finding them in spindle cell tumors justifies a diagnosis of myofibroblastomas. There have been several stromal changes diagnostic for certain tumors found only by electron microscopy. Fibrous long-spaced collagen (known as Luse bodies) is diagnostic for peripheral nerve sheath tumors, but they can rarely be found in other tumors. Luse bodies usually appear as focally as crystallized aggregates apart from the regular collagenous interstitial stroma. They should be distinguished from other nonspecific long-spaced collagen changes. The changes are diffusely stromal in contrast to Luse bodies. Spiny collagen and amianthoid fibers are interesting collagen fibrils and their diagnostic value is questionable. Skeinoid fibers (SF) are short-spaced collagen of 41- to 45-nm banding so-named because of their peculiar appearance by electron microscopy simulating skeins of yarn. They were originally described in neurogenic tumors and small intestinal stromal tumors with features of gastrointestinal autonomic nerve tumors (GANT). Although there have been a few sporadic case reports of the presence of skeinoid fibers in nonneurogenic tumors, the frequent presence of SF in spindle cell tumors signifies their neurogenic nature in this authors' experience. An exception to this is that SF can be a constant element of rare ciliary body tumors known as ciliary mesectodermal leiomyomas, in which tumor cells show some resemblance to smooth muscle as well as Schwann cells. In addition to SF, several other types of peculiar crystallized collagen were observed in GANT tumors, particularly those with multiple tumor syndromes such as neurofibromatosis and Carney's triad. They simulate the appearance of railroad tracks or centrosomes. The reason for this is not known. The authors speculate that such collagen crystallization may be caused by genetic alterations involving collagenosis. Further studies will be necessary to clarify their pathogenesis. Another peculiar stromal change is electron-dense stromal filamentous aggregates with extra-long banding of > 250-nm periodicity previously described in Ewing sarcomas. This stromal change simulating a tiger skin pattern is also seen in primitive neuroectodermal tumors and malignant melanomas. In view of continually new discoveries of stromal changes that can be used for the differential diagnosis of tumors, the importance of close evaluation of stromal elements of tumors, and diligent application of electron microscopy in tumor diagnosis cannot be overemphasized.

Cytoplasm↗
PubMed2006

A critical assessment of studies on the carcinogenic potential of diesel exhaust.

After decades of research involving numerous epidemiologic studies and extensive investigations in laboratory animals, a causal relationship between diesel exhaust (DE) exposure and lung cancer has not been conclusively demonstrated. Epidemiologic studies of the transportation industry (trucking, busing, and railroad) show a small elevation in lung cancer incidence (relative risks [RRs] generally below 1.5), but a dose response for DE is lacking. The studies are also limited by a lack of quantitative concurrent exposure data and inadequate or lack of controls for potential confounders, particularly tobacco smoking. Furthermore, prior to dieselization, similar elevations in lung cancer incidence have been reported for truck drivers, and in-cab diesel particulate matter (DPM) exposures of truck drivers were comparable to ambient highway exposures. Taken together, these findings suggest that an unidentified occupational agent or lifestyle factor might be responsible for the low elevations in lung cancer reported in the transportation studies. In contrast, underground miners, many of whom experience the highest occupational DPM exposures, generally do not show elevations in lung cancer. Laboratory studies must be interpreted with caution with respect to predicting the carcinogenic potential of DE in humans. Tumors observed in rats following lifetime chronic inhalation of very high levels of DPM may be attributed to species-specific overload mechanisms that lack relevance to humans. Increased tumor incidence was not observed in other species (hamsters or mice) exposed to DPM at very high levels or in rats exposed at lower levels (</=2000 mug/m3). Although DPM contains mutagens, mutagenicity studies in which cells were exposed to concentrated extracts of DPM also have limited application to human risk assessment, because such extracts can be obtained from DPM only by using strong organic solvents, agitation, and heat. Most studies have shown that whole DPM itself is not mutagenic because the adsorbed organic compounds are minimally bioavailable in aqueous-based fluids. In the past two decades, dramatic changes in diesel engine technology (e.g., low-sulfur fuel and exhaust after-treatment) have resulted in >99% reduction in DPM and other quantitative and qualitative changes in the chemical and physical characteristics of diesel exhaust. Thus, the current database, which is focused almost entirely on the potential health effects of traditional diesel exhaust (TDE), has only limited utility in assessing the potential health risks of new-technology diesel exhaust (NTDE). To overcome some of the limitations of the historical epidemiologic database on TDE and to gain further insights into the potential health effects of NTDE, new studies are underway and more studies are planned.

Air Pollutants↗
PubMed2000

A fuel-based assessment of off-road diesel engine emissions.

The use of diesel engines in off-road applications is a significant source of nitrogen oxides (NOx) and particulate matter (PM10). Such off-road applications include railroad locomotives, marine vessels, and equipment used for agriculture, construction, logging, and mining. Emissions from these sources are only beginning to be controlled. Due to the large number of these engines and their wide range of applications, total activity and emissions from these sources are uncertain. A method for estimating the emissions from off-road diesel engines based on the quantity of diesel fuel consumed is presented. Emission factors are normalized by fuel consumption, and total activity is estimated by the total fuel consumed. Total exhaust emissions from off-road diesel equipment (excluding locomotives and marine vessels) in the United States during 1996 have been estimated to be 1.2 x 10(9) kg NOx and 1.2 x 10(8) kg PM10. Emissions estimates published by the U.S. Environmental Protection Agency are 2.3 times higher for both NOx and exhaust PM10 emissions than estimates based directly on fuel consumption. These emissions estimates disagree mainly due to differences in activity estimates, rather than to differences in the emission factors. All current emission inventories for off-road engines are uncertain because of the limited in-use emissions testing that has been performed on these engines. Regional- and state-level breakdowns in diesel fuel consumption by off-road mobile sources are also presented. Taken together with on-road measurements of diesel engine emissions, results of this study suggest that in 1996, off-road diesel equipment (including agriculture, construction, logging, and mining equipment, but not locomotives or marine vessels) was responsible for 10% of mobile source NOx emissions nationally, whereas on-road diesel vehicles contributed 33%.

Air Pollutants, Occupational↗
PubMed2003

Thermal exploitation of wastes with lignite for energy production.

The thermal exploitation of wastewood with Greek lignite was investigated by performing tests in a laboratory-scale fluidized bed reactor, a 1-MW(th) semi-industrial circulating fluidized bed combustor, and an industrial boiler. Blends of natural wood, demolition wood, railroad sleepers, medium-density fiberboard residues, and power poles with lignite were used, and the co-combustion efficiency and the effect of wastewood addition on the emitted pollutants were investigated. Carbon monoxide, sulfur dioxide, and oxides of nitrogen emissions were continuously monitored, and, during the industrial-scale tests, the toxic emissions (polychlorinated dibenzodioxins and dibenzofurans and heavy metals) were determined. Ash samples were analyzed for heavy metals in an inductively coupled plasma-atomic emission spectroscopy spectrophotometer. Problems were observed during the preparation of wastewood, because species embedded with different compounds, such as railway sleepers and demolition wood, were not easily treated. All wastewood blends were proven good fuels; co-combustion proceeded smoothly and homogeneous temperature and pressure profiles were obtained. Although some fluctuations were observed, low emissions of gaseous pollutants were obtained for all fuel blends. The metal element emissions (in the flue gases and the solid residues) were lower than the legislative limits. Therefore, wastewood co-combustion with lignite can be realized, provided that the fuel handling and preparation can be practically performed in large-scale installations.

Bioelectric Energy Sources↗
PubMed1998

Identification of Ergonomic-Related Hazards in an Industrial Sample Using the National Occupational Exposure Survey.

The National Occupational Exposure Survey (NOES) was used to determine probabilities for 4 potential physical-agent and 10 potential ergonomic-related exposure hazards among a representative sample of U.S. industries. Potential physical-agent hazard exposures, principally whole-body and segmental vibration, were highest among railroad and heavy construction industries. Several construction industries had high probabilities of potential ergonomic-related exposure hazards, especially to the back and upper extremities. Establishments with 100 to 249 employees had the highest probability of potential exposures to the 2 types of hazards. Measures of safety and health climate did not differ consistently between high-hazard and low-hazard establishments. The approach taken in this paper may be used to help identify highrisk industries, evaluate interventions, and develop inspection strategies.

exposures↗
PubMed2002

Bioabsorbable SR-PLGA horn stent after antegrade endopyelotomy: a case report.

PURPOSE: To evaluate the suitability of a bioabsorbable stent as a partial internal catheter after percutaneous endopyelotomy in ureteropelvic junction (UPJ) obstruction therapy. PATIENT AND METHODS: The material for the helical spiral stents was a copolymer of polylactide and glycolide (PLGA; L:G ratio 80/20). The self-reinforcement (SR) was accomplished by heating and drawing by Bionx Implants Ltd, Tampere, Finland. The stents were horn shaped, with an initial outside diameter 6 to 3.0 mm +/- 0.2 mm and a length of 90 mm. The stent was partially degraded before insertion so it would degrade faster from the distal end, proceeding gradually to the proximal end. According to in vitro estimation, the degradation time of the material was 2 to 2.5 months. The railroaded cold-knife technique was used for antegrade endopyelotomy. After relief of the UPJ obstruction, the stent was pushed to the upper ureter. RESULTS: The 37-year-old male patient had under open pyeloplasty 5 years previously. He had a pelvic stone 32 mm in diameter and tight restenosis of the UPJ. Percutaneous lithotripsy, incision of the stenosis, and application of the SR-PLGA helical horn-shaped spiral stent was without early or late complications. Eighteen months after the operation, retrograde pyelography showed the UPJ to be totally unobstructed. CONCLUSIONS: The bioabsorbable horn-shaped SR-PLGA helical spiral stent proved a suitable alternative for stenting of the UPJ after antegrade endopyelotomy, bringing a reduced need for postoperative percutaneous kidney drainage and no need for subsequent stent removal. The bioabsorbable helical stent works as a partial catheter, which prevents vesicoureteral reflux and reduces the risk of postoperative renal infection.

Adult↗
PubMed1987

A case-control study of bladder cancer using city directories as a source of occupational data.

Commercial city directories, currently produced in 1,250 United States cities, potentially provide yearly information on occupation and employer for all city residents over age 18 years. To investigate the usefulness of these occupational data, the authors have conducted a case-control study of male bladder cancer mortality in Hamilton County, Ohio (which includes Cincinnati). A total of 731 bladder cancer cases who died during 1960-1982 were matched on age, sex, race, date-of-death, and residence at death to two controls per case. Risks of bladder cancer death were calculated by occupation, industry, and specific employer, using both city directories (multiple statements) and death certificates (single statement). Four companies showed a significant excess bladder cancer risk when using city directories. Only one would have been identified using death certificates, which ask for usual lifetime type of industry rather than a specific company name. Using city directories, significant positive associations were found between bladder cancer and occupation as an engineer, tailor, carpenter, furnace operator, blending machine operator, chemist, pressing machine operator, house cleaner, or salesman. For industry, the authors found significant positive associations for the textile, chemical, grain mill, foundry, petroleum, building service, entertainment, and advertising industries. A significant increase in risk for those with 20 or more years of employment was seen for those employed as truck drivers and furnace operators, or those employed in the railroad industry. A check of the validity of city directory data indicated that 77 per cent of the listings agreed with Social Security earnings reports for employer in any given year. One limitation of Hamilton County city directory data was the fairly large number of yearly listings without any occupational data (15 per cent for occupation, 36 per cent for employer). While city directory data do provide work history over time, unlike death certificates, such data are available only for years of residence in the city in question.

Death Certificates↗
PubMed2006

Occupational exposure to diesel exhausts and risk for lung cancer in a population-based case-control study in Italy.

BACKGROUND: We studied the effect of exposure to diesel exhausts on lung cancer risk in a population-based case-control study in the city of Turin, Italy. PATIENTS AND METHODS: Information on occupational histories of 595 incident lung cancer cases diagnosed in 1991-1992 and 845 population controls was obtained. During the interviews, diesel job-specific modules (D-JSMs) were administered whenever subjects had worked in occupations included in the following nine categories: railroad workers, miners, professional drivers and transport conductors, heavy-machine operators, mechanics and testers, filling station attendants, motor-vehicle park attendants, transport equipment operators, and occupations carried out in/near urban roads. All D-JSMs were evaluated for probability, intensity and frequency of exposure. RESULTS: The odds ratio for ever exposure to diesel exhausts was 1.04 (95% confidence interval 0.79-1.37), after adjusting for age, sex, smoking and having worked in occupations entailing exposure to known lung carcinogens. No association was found with intensity, probability and duration of exposure. CONCLUSIONS: Although misclassification of the exposure may have contributed to the negative results, we did not find an association between occupational exposure to diesel exhausts and lung cancer risk.

Case-Control Studies↗
PubMed2004

Randomized, controlled trial of the double setup tracheal tube during fibreoptic orotracheal intubation under general anaesthesia.

BACKGROUND: Impingement of the tracheal tube (ETT) on upper airway structures during railroading over the fibreoptic bronchoscope (FOB) occurs commonly. Potential complications of impingement include prolonged intubation time, leading to arterial desaturation, failed intubation and laryngeal trauma. The objective of this randomized, controlled trial was to assess the effect of the double setup ETT (a paediatric ETT is placed inside an adult ETT) on the incidence of impingement during orotracheal fibreoptic intubation. METHOD: Two hundred patients were randomized to have a single ETT or double setup ETT. After induction of anaesthesia, fibreoptic orotracheal intubation was performed. The degree of impingement of the ETT during advancement over the FOB was assessed using a standardized scoring system based on the manoeuvres required to overcome the impingement. RESULTS: The incidence of impingement was lower using the double setup ETT compared with the single ETT (18 vs 93%, P<0.001). The double setup ETT also reduced the incidence of impingement requiring more than a simple 90 degrees counterclockwise rotation to achieve intubation (3 vs 14%, P=0.01) and reduced the median intubation time (31 vs 35 s, P=0.046). CONCLUSIONS: The double setup ETT is effective in reducing ETT impingement and in reducing intubation time. We did not find an association between ETT impingement and arterial desaturation.

Adolescent↗
PubMed2005

Bougie-guided insertion of the ProSeal laryngeal mask airway has higher first attempt success rate than the digital technique in children.

BACKGROUND: We tested the hypothesis that bougie-guided insertion of the ProSeal laryngeal mask airway (ProSeal LMA) has higher success rate than the digital technique in children. METHODS: One hundred and twenty children (ASA I-II, aged 1-16 yr) were randomly allocated for ProSeal LMA insertion using the digital or bougie-guided technique. The digital technique was performed according to the manufacturer's instructions. The bougie-guided technique involved priming the drain tube with a bougie, placing the bougie in the oesophagus under direct vision and railroading the ProSeal LMA into position. Unblinded data were collected about ease of insertion (number of attempts and time taken to provide an effective airway), efficacy of seal, ease of gastric tube placement, haemodynamic responses and blood staining. Blinded data were collected about postoperative airway morbidity. RESULTS: The first attempt success rate was higher for the bougie-guided technique (59/60 vs 52/60, P=0.015), but effective airway time was longer (37 vs 32 s, P<0.001). There were no differences in efficacy of seal, ease of gastric tube placement, haemodynamic responses, blood staining or postoperative airway morbidity. CONCLUSION: We conclude that bougie-guided insertion of the ProSeal LMA has a higher first attempt success rate than the digital technique in children.

Adolescent↗
PubMed2004

Inequality and leprosy in Northeast Brazil: an ecological study.

BACKGROUND: Leprosy is an important public health problem in many developing countries and many features of its determinants are still obscure. METHODS: To investigate whether the incidence of leprosy is related to certain environmental and socioeconomic determinants, an ecological study was undertaken in 165 municipalities of the state of Ceará, Brazil. Social, economic, education, sanitation, demography, meteorology, and health data were collected. The dependent variable was the average incidence rate of leprosy from 1991 to 1999. Simple and multiple linear regressions were performed to assess the relationship between the dependent and the independent variables. RESULTS: The average incidence rate for all the municipalities for the 1991-1999 period, varied from 0.06 to 14.68 per 10000 persons per year. The level of inequality (beta = 1.67, P = 0.011), the mean years of study among the population >or=25 years old (beta = 1.35, P < 0.001), the population growth from 1991 to 1996 (beta = 0.02, P = 0.007), the percentage of children 7-14 years old that did not go to the school (beta = 0.02, P = 0.028), and the presence of a railroad in the municipality (beta = 0.45, P = 0.038) were found to be predictors of the incidence rate of leprosy in Ceará. CONCLUSION: Our findings fit the assumption that, in Ceará, leprosy is associated with a high level of poverty and uncontrolled urbanization. We put forward the hypothesis that urbanization increases not only social inequality eventually leading to strong polarization, but also excludes people from social and material opportunities. Apparently, such deprivations render them susceptible for leprosy.

Adolescent↗
PubMed2004

Handoff strategies in settings with high consequences for failure: lessons for health care operations.

OBJECTIVE: To describe strategies employed during handoffs in four settings with high consequences for failure. DESIGN ANALYSIS: of observational data for evidence of use of 21 handoff strategies. SETTING: NASA Johnson Space Center in Texas, nuclear power generation plants in Canada, a railroad dispatch center in the United States, and an ambulance dispatch center in Toronto. MAIN MEASURE: Evidence of 21 handoff strategies from observations and interviews. RESULTS: Nineteen of 21 strategies were used in at least one domain, on at least an 'as needed' basis. CONCLUSIONS: An understanding of how handoffs are conducted in settings with high consequences for failure can jumpstart endeavors to modify handoffs to improve patient safety.

Canada↗
PubMed1980

Hitler and Bormann identifications compared by postmortem craniofacial and dental characteristics.

After Stalin told President Truman at Potsdam, July 17, 1945, that Hitler got away, a secret U.S. mission was designated to establish anthropological skull projections pertinent to a potential recovery of Hitler's remains, i.e., by experimentally eliminating the "flesh." Then, conversely, in 1972, when one of the two skulls unearthed next to the Lehrter Railroad station in West Berlin (where Hitler's physician and Bormann had last been seen alive on May 2, 1945), an attempt was made to put facial flesh back on the skull with a view to reconstruct the original facial physiognomy of Martin Bormann. All things considered, it will be documented that the only convincing forensic evidence of Hitler's and Bormann's deaths proved to be the dental data.

Adult↗
PubMed1990

Brake mechanics, asbestos, and disease risk.

Health risks posed by inhalable asbestos fibers are known to exist in a variety of industrial and nonindustrial settings. Although early studies described an increased risk of asbestosis, lung cancer, and mesothelioma in asbestos-industry workers, subsequent research revealed the existence of a potential asbestos-related health hazard in nonasbestos industries such as the textile and railroad industries. Brake mechanics and garage workers constitute a large work force with potential exposures to levels of asbestos capable of producing disease. Unfortunately, the health risk faced by these workers has received little attention. This article briefly discusses currently available information on the asbestos health risks of workers in this setting, and highlights the need for further investigations of this occupational group.

Asbestos↗
PubMed2001

A meta-analysis of bladder cancer and diesel exhaust exposure.

The aim of this study is to review and summarize the available epidemiologic studies of bladder cancer and occupational exposure to diesel exhaust. We retrieved relevant studies and abstracted their characteristics and results. We assessed the heterogeneity of the results to decide whether to perform a fixed-effects model meta-analysis. We identified 35 relevant studies. No overall meta-analysis was performed because of heterogeneity in results. Results of railroad workers (N = 14) suggested an increased occurrence of bladder cancer, but we did not conduct a meta-analysis. The summary relative risk (RR) among truck drivers was 1.17 (95% confidence interval [CI] = 1.06-1.29, 15 studies) and that among bus drivers was 1.33 (95% CI = 1.22-1.45, 10 studies). Ten studies considered diesel exhaust exposure based on a job exposure matrix or a similar approach; the summary RR for these studies was 1.13 (95% CI = 1.00-1.27). A positive dose-response relation was suggested by 10 of the 12 studies that provided relevant information. The summary RR for high diesel exposure was 1.44 (95% CI = 1.18-1.76). There was some evidence of publication bias, however, with a lack of small studies with null or negative results. Our review suggests that exposure to diesel exhaust may increase the occurrence of bladder cancer, but the effects of misclassification, publication bias, and confounding cannot be fully taken into account.

Europe↗
PubMed1984

Traumatic hemipelvectomy in combination with traumatic amputation of an upper extremity.

This is a report of a 16-year-old survivor of a traumatic hemipelvectomy in combination with an amputation of the upper extremity on the ipsilateral side. The injury was caused when the patient fell under a railroad train. There were associated injuries of the genitourinary tract and the rectum. Factors that contributed to the patient's survival were: 1) the excellent care he received at the scene of the accident by the paramedics of the regional emergency care system; 2) a rapid transportation to the hospital by a life flight helicopter; and 3) a concentrated effort by the general surgery, plastic surgery, and urologic surgery teams in providing vigorous, sustained, and comprehensive preoperative, operative, and postoperative care.

Adolescent↗