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67 records · Page 4Linked to original sources
PubMed2003

The response of Dahl salt-sensitive and salt-resistant female rats to a space flight model.

Vitamin D metabolism in the Dahl salt-sensitive (S) rat, a model of salt-induced hypertension, differs from that in the Dahl salt-resistant (R) rat. We have tested the hypothesis that differences in vitamin D metabolism would render the Dahl S rat more susceptible than the Dahl R rat to the effects of a space flight model. Dahl female rats were tail suspended (hind limb unloaded) for 28 days, while fed a low salt (3 g/kg sodium chloride) diet. Plasma 25-OHD concentrations of S rats were significantly lower than that of R rats. Plasma 1,25-(OH)2D concentration was 50% lower in unloaded than in loaded S rats, but was unaffected in unloaded R rats. The left soleus muscle weight and breaking strength of the left femur (torsion test) were 50% and 25% lower in unloaded than in loaded S and R rats. The mineral content of the left femur, however, was significantly lower (by 11%) only in unloaded S rats. We conclude that female S rats are more vulnerable than female R rats to decreases in plasma 1,25-(OH)2D concentration and femur mineral content during hind limb unloading, but equally vulnerable to muscle atrophy and reduced breaking strength of the femur.

Animals↗
PubMed1998

Interhospital versus direct scene transfer of major trauma patients in a rural trauma system.

The purpose of organized trauma systems is to ensure the expeditious transfer of seriously injured patients to the facility best equipped to care for their injuries. Patients are referred to our trauma center, either by ambulance or helicopter, directly from the scene or through interhospital transfer. We examined the difference in outcome between those patients sent directly to the trauma center versus those seen at other hospitals and subsequently referred to the trauma center. Our hypothesis was that a delay at the referring hospital is detrimental to patient outcome. Adult trauma patients with Injury Severity Scores > 15, treated over 16 months from July 1, 1994, to October 31, 1995, were studied. Patients who survived 24 hours experienced significantly shorter intensive care unit (14 vs 10 days; P < 0.05) and hospital (21 vs 16 days; P < 0.05) lengths of stay when taken directly to the trauma center. In addition, there were significantly fewer deaths in patients with a probability of survival > 0.5 and a slightly lower overall mortality in those patients who survived at least 1 day. This study demonstrates that patients with major trauma taken directly to the trauma center had shorter hospital and intensive care unit stays and lower mortality. The study supports the paradigm that, when possible, major trauma patients should be sent to trauma centers directly from the injury scene.

Adult↗
PubMed1998

Blunt splenic trauma: characteristics of patients requiring urgent laparotomy.

In victims of blunt abdominal trauma, the spleen is the most common organ damaged, it is the most likely source of serious injury, and is associated with significant morbidity and mortality. The participants in this study were emergency department (ED) patients with splenic trauma determined via imaging study, surgical exploration, or autopsy. Patients were located using both the institution's trauma registry and discharge diagnoses (ICD-9 codes) involving splenic injury resulting from blunt trauma. Medical records including pre-hospital, ED, and hospital information were reviewed. Chi Square and Fisher's exact test were used for statistical analysis where appropriate, with a P value of less than 0.05 considered significant. Fifty-five patients (60% male) were analyzed with a mean age of 31 years (range, 1 to 78 years). Sixteen (30%) patients (mean age 44 years) were managed operatively, with 14 patients receiving only a diagnostic peritoneal lavage. All 38 patients (70%, mean age 26 years) who received nonoperative management were diagnosed by computed tomography. The motor vehicle crash represented the most frequent mechanism of injury in both groups; the nonoperative group, however, experienced other injury mechanisms more frequently. Clinical variables suggestive of the need for urgent surgical intervention (from ED to the surgical suite) include hypotension (systolic blood pressure less than 90 mm/Hg) in the pre-hospital setting or ED; tachycardia (heart rate greater than 100 beats/min) in the ED; abnormal hematocrit (less than 30) or coagulopathy (prothrombin time greater than 14 seconds) in the ED; multiple injuries; or blood transfusion in the ED. Complaints of pain resulting from traumatic injury and abdominal examination findings did not identify patients requiring urgent operative management. Hemodynamic instability, evidence of multiple injuries, abnormal laboratory parameters, and the requirement for blood transfusion in the ED identifies a patient population likely to require operative therapy of their splenic injury. Emergency physicians should consider early surgical consultation or urgent transfer to the regional trauma center in patients with these characteristics.

Adolescent↗
PubMed1998

A protocol for the initial management of unstable pelvic fractures.

The initial management of life-threatening hemorrhage associated with severe pelvic fractures has long been a source of debate. A review of the literature reveals that many advocate emergent orthopedic external fixation (EX-FIX) for severe pelvic fractures, whereas others claim greater success with angiographic embolization (ANGIO) as the first line of treatment. Although many have attempted to classify management options by fracture pattern, to date there has been no prospective trial comparing outcomes for each method of treatment. We offer a prospective study of all pelvic fracture patients admitted to our Level I trauma center between July 1994 and July 1995. Patients were classified according to fracture pattern and degree of hemodynamic instability. Those with primarily anterior pelvic ring fractures underwent emergent EX-FIX for control of hemorrhage, whereas those with primarily posterior pelvic ring fractures underwent emergent ANGIO to control hemorrhage. We found that blood product requirements and hospital stay were similar in each group. However, the complication rate was higher in patients who underwent initial emergency EX-FIX, primarily because of failure to adequately control hemorrhage. We conclude that patients with anterior-posterior compression type 2 and 3, lateral compression type 2 and 3, or vertical shear injuries, who are hemodynamically unstable as a result of their pelvic fracture, should undergo immediate ANGIO if laparotomy is not indicated. If laparotomy is indicated, EX-FIX should be placed intraoperatively, followed by postoperative ANGIO.

Acidosis, Lactic↗