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PubMed2006

Survived crossbow injuries.

The Hamburg University Institute of Legal Medicine presents 2 cases of injuries of crossbow arrows where the patients survived. Crossbows are used nowadays as sports and hunting weapons. They are freely obtainable, and since people without practice can shoot them, there are constant injuries and fatal cases. Crossbow arrows have a high penetration force and can even pierce bone. Depending on the tip of the arrow used, they bore or cut through tissue, here damage to the tissue being restricted to the direct surroundings. Due to the elasticity of the tissue, the arrow shaft in the wound track may have the effect of an incomplete tamponade so that major hemorrhaging is prevented. In this condition, the injured person may be conscious and capacitated. From the medical viewpoint, crossbow arrows should therefore be invariably left in the wound, secured against displacement during transport, and only removed in the hospital.

Accidents↗
PubMed2004

The vascular anatomy of the digastric muscle.

There are plenty of flaps for the reconstruction of defects of the head and neck region. In the literature, local muscle and myocutaneous flaps such as sternocleidomastoid, pectoral, and deltopectoral flaps are proposed for obliteration of pharyngocutaneous fistulas. Restoration of facial nerve palsies in which nerve repair and nerve grafting are not feasible is accomplished by means of regional muscle transpositions. The vascular anatomy of the digastric muscle to be used in such instances is investigated after latex application to 18 neck regions of nine cadavers. The dissection continued anteriorly from the origin of the facial artery to the end of the submental artery, preserving all the branches piercing and nourishing the muscle. The submental artery courses over the posterior surface of the anterior belly of the digastric muscle, giving off the major pedicle of the muscle 1 cm after exiting behind the submandibular gland. The submental artery gives off another branch, the first minor pedicle of the muscle distal to the major pedicle at a distance of two thirds of the muscle length in a standard fashion in all the cadavers. The artery ends in the distal portion of the muscle, the second minor pedicle of the muscle. The artery gives off periosteal branches to the mandible after coursing through the insertion muscle. The anterior belly of the digastric muscle could be classified as a type II muscle, with a major pedicle and two minor pedicles, according to the system of Mathes and Nahai. The anterior digastric muscle can be a good alternative in obliteration of pharyngocutaneous fistulas, and defects of the mandible, including the body and angle of the mandible, can be amended with the split mandibular myo-osseous digastric flap.

Adult↗
PubMed1975

Comparative anatomical study of the hyoid apparatus in selected primates.

This paper embodies a comparative study of the hyoid apparatus in six species of primates. There is a direct correlation between a predominantly herbivorous diet and an increase in the relative size of the basihyal (the body) of the hyoid bone. The basihyal has a deep "cup-shaped" concavity in the howler but is very flat in the marmoset. The baboon, rhesus and capuchin fall in between these two extremes. The configuration and size of the basihyal are directly proportional to the presence or absence and the size of the median air-sacs. Of the species studied, the posterior cornu (thyrohyal) of the hyoid bone is present in all the species, but the hypohyal is present only in the baboon, rhesus and capuchin. A true styloid process is found only in the baboon, although the rhesus has a bony spicule. All except the howler have a stylomandibular ligament from which arise the stylohyoid, stylopharyngeus and styloglossus muscles. The anterior bellies of the two sides of the digastric muscle are truly united only in the marmoset, but are approximated in the baboon and rhesus. The stylohyoid muscle at its insertion into the basihyal is pierced by the intermediate tendon of the digastric muscle in the rhesus and capuchin, but not in the howler and baboon. In the marmoset the presence of a stylohoid muscle is variable.

Animals↗
PubMed2005

A review of free radicals and antioxidants for critical care nurses.

In the critical care setting, nurses frequently care for patients with acute and chronic diseases that affect multiple body systems. Many of these medical conditions have been associated with an imbalance between oxidizing chemicals called free radicals and antioxidants. Free radical damage is now assumed to be a contributing factor in all major diseases. In order to provide the most current and comprehensive care, critical care nurses need to be well informed about how free radicals cause damage and the antioxidant compounds that neutralize their destructive effects. This article provides an overview of oxygen free radicals and antioxidants and how they impact different clinical illnesses familiar to critical care nurses.

Antioxidants↗
PubMed1983

The role of lysosomes in the pathogenesis of copper-induced hepatotoxicity. II. Intracellular distribution of copper in hepatocytes.

The effects of altered lysosomal function on the pathogenesis of copper-induced hepatotoxicity were studied in C57B1/6 bg/bg (beige) and C57B1/6 bg/+ (conventional) mice. Copper loading was accomplished through daily ip injections of aqueous copper chloride at a dosage rate of 8 mg/kg body weight for 1, 2, and 4 weeks. The subcellular distribution of copper in copper-treated beige mice was significantly different than that in conventional mice. Beige mice had consistently higher levels of copper in the nuclear and cytosolic fractions with lower levels in the heavy and light mitochondrial fractions. The copper levels were lowest in the microsomal fractions of both groups of copper-treated mice and remained similar throughout the 4-week experiment. Levels of total hepatic copper were similar in both groups of mice receiving parenteral copper except at Day 14, when beige mice had higher levels.

Animals↗
PubMed2006

Injury hospitalizations: using the nationwide inpatient sample.

BACKGROUND: The aims of this study are to develop estimates of discharge rates and frequencies for all injury-related hospitalizations in the United States for the year 2000 and to characterize patterns of hospitalized injury and anatomic region using a modified Barell Matrix. The utility of the Nationwide Inpatient Sample (NIS) for providing national estimates of hospitalized injuries will be discussed. METHODS: This study is a retrospective analysis of hospital discharge data using the Nationwide Inpatient Sample. All hospital discharges with a primary diagnosis of injury were selected. Total number of hospitalizations, annual discharge rates, and 95% confidence intervals were calculated by body region, nature of injury, and injury mechanism. Number of injuries by age, sex, body region, and nature of injury were also calculated for falls and motor vehicle crashes. RESULTS: In 2000, there were an estimated 1,690,780 hospital discharges with a primary injury diagnosis. Discharge rates were highest for the oldest age groups. Falls and motor vehicle crashes were the leading causes of hospitalization. Fracture was the most common diagnosis and lower extremity injury was the most common anatomic region. CONCLUSIONS: Hospital discharge data adds another dimension to our understanding of the total injury burden. The Nationwide Inpatient Sample may be useful in providing national estimates of hospital discharges.

Accidental Falls↗
PubMed1988

Theiler's virus infection in nude mice: viral RNA in vascular endothelial cells.

Infection of athymic (nu/nu) mice with Theiler's murine encephalomyelitis virus results in an acute encephalitis which resembles poliomyelitis. Immunohistochemistry and in situ hybridization were used to delineate the presence of viral proteins and RNA in the nervous systems of nude mice infected with the Daniels strain of Theiler's virus. This system permits the analysis of a viral infection in the absence of an effective immune response. By immunohistochemistry, viral antigen was found in the processes and cell bodies of neurons and glial cells. Besides the presence of viral antigen in these cell types, by in situ hybridization, Theiler's virus RNA was also found in cells associated with vascular endothelium in the brains and spinal cords of these infected mice. Theiler's virus RNA-positive endothelial cells were observed not only near the primary lesions but also away from demonstrable lesions in normal-appearing regions in the central nervous system. Earlier work had suggested an intra-axonal dissemination for this virus (M. C. Dal Canto and H. L. Lipton, Am. J. Pathol. 106:20-29, 1982). Our findings are consistent with this model but also suggest an additional mechanism for virus spread within the central nervous system, i.e., by infecting vascular cells and crossing the blood-brain barrier. Lastly, after Theiler's murine encephalomyelitis virus infection, not only glial cells but also endothelial cells express major histocompatibility complex class II (la) antigen on their surface (M. Rodriguez, M. L. Pierce, and E. A. Howie, J. Immunol. 138:3438-3442, 1987). Our demonstration of Theiler's virus-infected endotheliumlike cells may explain interactions of virus products in stimulating antigen presentation.

Animals↗
PubMed2006

Life satisfaction after traumatic brain injury and the World Health Organization model of disability.

OBJECTIVE: To determine which components of the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) are most predictive of global life satisfaction after traumatic brain injury (TBI). DESIGN: Prospective evaluation of 180 individuals enrolled in a TBI model system project site. RESULTS: Multiple regression analysis indicated that the combination of ICF components (body function and structure, activities, and participation) and demographic factors significantly predicted life satisfaction and accounted for 17% of the variance. Participation was the strongest predictor; activities were a significant, but weaker predictor; and body function and structure did not add to the prediction of life satisfaction. Of all the individual variables evaluated, only social integration and productivity were found to be significant, unique predictors. CONCLUSIONS: When considering the effects of various aspects of disabling conditions on the life satisfaction of individuals who have suffered a TBI, restriction of participation in life activities was found to have the greatest impact. Although the model accounted for a significant percentage in the variation of life satisfaction, a large proportion of the predictive picture (>82%) remains unclear. Doubtless, other variables impinge on life satisfaction that would further clarify the complex relationship between disabling conditions and life satisfaction in TBI.

Activities of Daily Living↗
PubMed2006

Planning the breast tumor bed boost: changes in the excision cavity volume and surgical scar location after breast-conserving surgery and whole-breast irradiation.

PURPOSE: The aims of this study were to determine the changes in breast and excision cavity volumes after whole-breast irradiation and the adequacy of using the surgical scar to guide boost planning. METHODS AND MATERIALS: A total of 30 women consecutively treated for 31 breast cancers were included in this study. Simulation CT scans were performed before and after whole-breast irradiation. CT breast volumes were delineated using clinically defined borders. Excision cavity volumes were contoured based on surgical clips, the presence of a hematoma, and/or other surgical changes. Hypothetical electron boost plans were generated using the surgical scar with a 3-cm margin and analyzed for coverage. RESULTS: The mean CT breast volumes were 774 and 761 cc (p = 0.22), and the excision cavity volumes were 32.1 and 25.1 cc (p < 0.0001), before and after 40 Gy (39-42 Gy) of whole-breast irradiation, respectively. The volume reduction in the excision cavity was inversely correlated with time elapsed since surgery (R = 0.46, p < 0.01) and body weight (R = 0.50, p < 0.01). The scar-guided hypothetical plans failed to cover the excision cavity adequately in 62% and 53.8% of cases using the pretreatment and postradiation CTs, respectively. Per the hypothetical plans, the minimum dose to the excision cavity was significantly lower for tumors located in the inner vs. outer quadrants (p = 0.02) and for cavities >20 cc vs. <20 cc (p = 0.01). CONCLUSIONS: This study demonstrates a significant reduction in the volume of the excision cavity during whole-breast irradiation. Scar-guided boost plans provide inadequate coverage of the excision cavity in the majority of cases.

Adult↗
PubMed2005

Plasma carotenoids and recurrence-free survival in women with a history of breast cancer.

PURPOSE: Previous studies suggest that diet may affect recurrence or survival rates in women who have been diagnosed with breast cancer. The purpose of this study was to examine the relationship between plasma carotenoid concentration, as a biomarker of vegetable and fruit intake, and risk for a new breast cancer event in a cohort of women with a history of early-stage breast cancer. METHODS: Participants were 1,551 women previously treated for breast cancer who were randomly assigned to the control arm of a diet intervention trial between March 1995 and November 2000. Outcome events were probed during semiannual interviews and verified by medical record review. During the period under study, 205 women had a recurrence or new primary breast cancer. Plasma carotenoid concentrations were measured in baseline blood samples. Hazard ratios (HR) and 95% CIs by quartiles of plasma carotenoids were computed, controlling for tumor stage, grade, and hormone receptor status; chemotherapy and tamoxifen therapy; clinical site; age at diagnosis; body mass index; and plasma cholesterol concentration. RESULTS: Women in the highest quartile of plasma total carotenoid concentration had significantly reduced risk for a new breast cancer event (HR, 0.57; 95% CI, 0.37 to 0.89), controlled for covariates influencing breast cancer prognosis. CONCLUSION: Plasma carotenoids are a biologic marker of intake of vegetables and fruit, so this observation supports findings from previous studies that have linked increased vegetable and fruit intake with greater likelihood of recurrence-free survival in women who have been diagnosed with early-stage breast cancer.

Adult↗
PubMed2005

Anatomical study of the pudendal nerve adjacent to the sacrospinous ligament.

The pudendal nerve (S3-S5) is a major branch of the sacral plexus. After branching from the sacral plexus, the pudendal nerve travels through three main regions: the gluteal region, the pudendal canal, and the perineum. In the gluteal region, the pudendal nerve lies posterior to the sacrospinous ligament. The relationship of the pudendal nerve to the sacrospinous ligament has important clinical ramifications, but there is a lack of literature examining the variations in pudendal nerve anatomy in the gluteal region. This study investigates the pudendal nerve trunking in relation to the sacrospinous ligament in 37 cadavers (73 sides of pelves) of 21 males and 16 females, ranging from 18-83 years of age. Pudendal nerve trunking could be grouped into five types: Type I is defined as one-trunked (41/73; 56.2%), Type II is two-trunked (8/73; 11%), Type III is two-trunked with one trunk as an inferior rectal nerve piercing through the sacrospinous ligament (8/73; 11%), Type IV is two-trunked with one as an inferior rectal nerve not piercing through the sacrospinous ligament (7/73; 9.5%), and Type V is three-trunked (9/73; 12.3%). In summary, 56.2% of pudendal nerves adjacent to the sacrospinous ligament were one-trunked, 31.5% were two-trunked and 12.3% were three-trunked. Fifteen inferior rectal nerves originated independently from the S4 root and never joined the main pudendal nerve. Eight of fifteen inferior rectal nerves pierced through the sacrospinous ligament, perhaps making it prone for entrapment. We measured the average diameter of the main trunk of the pudendal nerve to be 4.67 +/- 1.17 mm. We also measured the average length of the pudendal nerve trunks before terminal branching to be 25.14 +/- 10.29 mm. There was no significant statistical difference in the average length, average diameter, number of trunks, and pudendal nerve variations between male and female or right or left sides of the pelves. A detailed study of pudendal nerve trunking in relationship to the sacrospinous ligament would be useful for instruction in basic anatomy courses and in relevant clinical settings as well.

Adolescent↗
PubMed1994

Pyrrolizidine alkaloidosis of cattle associated with Senecio lautus.

Serious incidents of pyrrolizidine alkaloidosis of cattle in 10 herds exposed to the Australian native plant, Senecio lautus (Asteraceae), were seen in central Queensland during 1988-1992. The deaths of 226 cattle were recorded. A mean of 8% of cattle died in affected groups (range 2 to 58%). Sickness and deaths usually occurred some months after access to S lautus. Typically, affected cattle lost body condition to the point of emaciation before dying and had persistent diarrhoea. Some animals developed abnormal behaviour and died after a shorter illness. Liver specimens from affected cattle in all herds contained lesions consistent with pyrrolizidine alkaloidosis. Thin layer chromatography of extracts of blood and liver samples from cattle from 5 herds detected pyrrolic metabolites. The identity of these was confirmed by mass spectroscopy on samples from one herd. Unseasonal autumn and winter rain after a dry summer appeared to favour growth of S lautus at the expense of other pasture species. A subsequent dry period promoted consumption of S lautus and was followed by a cluster of poisoning incidents.

Animals↗
PubMed1987

Recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) shortens the period of neutropenia after autologous bone marrow transplantation in a primate model.

The effect of granulocyte-macrophage colony-stimulating factor (GM-CSF) on hematopoietic reconstitution after autologous bone marrow transplantation was evaluated in a primate model. Animals were given a continuous intravenous infusion of recombinant human GM-CSF for several days both before and after transplantation or only after the transplant procedure. Marrow ablation was accomplished by total body irradiation. In both groups of animals, the neutrophil count reached 1,000/mm3 by 8-9 d posttransplant compared with an interval of 17 and 24 d for two concurrent controls. After withdrawal of GM-CSF, neutrophil counts fell to values comparable to those observed in untreated controls. Accelerated recovery of platelet production was also observed in four of the five animals. Two additional animals were initially given GM-CSF several weeks posttransplantation because of inadequate engraftment. Prompt and sustained increases in neutrophil and platelet counts were observed. We conclude that GM-CSF may be useful in accelerating bone marrow reconstitution.

Agranulocytosis↗
PubMed2005

Is family history related to preventive health behaviors and medical management in breast cancer patients?

INTRODUCTION: Women diagnosed with breast cancer who also have a family history of the disease are at increased risk of developing additional primary breast or ovarian cancers. We investigated whether a relationship exists between family history and health behaviors in a cross-sectional study of breast cancer survivors. METHODS: Participants in the Women's Healthy Eating and Living (WHEL) Study (a randomized trial designed to test the effect of a plant-based diet on breast cancer recurrence) completed baseline questionnaires about their family history and health behaviors. Medical records and self-reports provided treatment data. Participants were defined as having a family history (FH+) if they met specific family history criteria (n=195), and were compared with women having no family history (FH-) of breast cancer (n=1736). RESULTS: The mean age of breast cancer diagnosis was 51.2 years for both groups, but FH+ women were more likely to be diagnosed before age 40. FH+ and FH- women had similar dietary patterns, alcohol intake, exercise patterns, body mass index and smoking histories. However, FH+ women were more likely to have undergone prophylactic contralateral mastectomy (OR=3.6, 95% CI=2.2 - 6.2) and bilateral oophorectomy (OR=1.6; 95% CI=1.0 - 2.3) following diagnosis, adjusted for age and time since diagnosis. The FH+ and FH- groups had similar patterns of use of anti-estrogen medications and frequency of medical follow-up. CONCLUSIONS: Breast cancer survivors with a strong family history of breast cancer are more likely to undergo surgical preventive measures to reduce their risk of additional cancer, but do not report undertaking more preventive lifestyle behaviors compared to breast cancer survivors without a family history.

Adult↗
PubMed1982

Distribution of amoxicillin and clavulanic acid in infected animals and efficacy against experimental infections.

The therapeutic effects produced by formulations of amoxicillin plus clavulanic acid (BRL 25 000A and BRL 25 000G) were compared with those of amoxicillin and clavulanic acid separately against a variety of infections produced by amoxicillin-susceptible and beta-lactamase-producing (amoxicillin-resistant) bacteria. The infection models studied included intraperitoneal infections, a mouse pneumonia, experimental pyelonephritis, and local lesions caused by Staphylococcus aureus and Bacteroides fragilis. The distribution of amoxicillin and clavulanic acid in infected animals after the administration of amoxicillin-clavulanic acid was evaluated by measurement of the concentrations of the substances present in specimens collected at the sites of infection. The results showed that both amoxicillin and clavulanic acid were well distributed in the animal body after the administration of amoxicillin-clavulanic acid formulations, being present in significant concentrations at various sites of infection, e.g., peritoneal washings, pleural fluid, pus, and infected tissue homogenates. In a number of cases, the amoxicillin concentrations measured after the administration of BRL 25000 were higher than those found after treatment with amoxicillin alone, presumably as a result of inhibition of bacterial beta-lactamases by clavulanic acid at the site of infection. The ability of clavulanic acid to protect amoxicillin in vivo was confirmed by the efficacy of amoxicillin-clavulanic acid formulations in the treatment of the infections studied, most of which were refractory to therapy with amoxicillin.

Amoxicillin↗
PubMed2002

Progressive photoreceptor degeneration, outer segment dysplasia, and rhodopsin mislocalization in mice with targeted disruption of the retinitis pigmentosa-1 (Rp1) gene.

Retinitis pigmentosa (RP), a common group of human retinopathic diseases, is characterized by late-onset night blindness, loss of peripheral vision, and diminished or absent electroretinogram (ERG) responses. Mutations in the photoreceptor-specific gene RP1 account for 5-10% of cases of autosomal dominant RP. We generated a mouse model of the RP1 form of RP by targeted disruption of the mouse ortholog (Rp1) of human RP1. In Rp1(-/-) mice, the number of rod photoreceptors decreased progressively over a period of 1 year, whereas that of cone photoreceptors did not change for at least 10 months. Light and electron microscopic analysis revealed that outer segments of Rp1(-/-) rods and cones were morphologically abnormal and became progressively shorter in length. Before photoreceptor cell death, rhodopsin was mislocalized in inner segments and cell bodies of Rp1(-/-) rods. Rod ERG amplitudes of Rp1(-/-) mice were significantly smaller than those of Rp1(+/+) mice over a period of 12 months, whereas those of Rp1(+/-) mice were intermediate. The decreases in cone ERG amplitudes were slower and less severe than those in rods. These findings demonstrate that Rp1 is required for normal morphogenesis of photoreceptor outer segments and also may play a role in rhodopsin transport to the outer segments. The phenotype of Rp1 mutant mice resembles the human RP1 disease. Thus, these mice provide a useful model for studies of RP1 function, disease pathology, and therapeutic interventions.

Animals↗
PubMed1996

Posterior approaches to the humerus: when should you worry about the radial nerve?

We used the olecranon osteotomy approach to the humerus on 75 cadaver arms and measured where the radial nerve pierced the intermuscular septum to determine the risk to that nerve during elevation of the triceps. We found the nerve an average of 10.0 cm from the distal articular surface in men and 9.4 cm in women; however, some cadavers had nerves as close as 7.5 cm. The humerus was also approached via a triceps split and the nerve located at the spiral groove. The distance from the articular surface to the nerve averaged 15.8 cm in men and 15.2 cm in women, with the minimum distance being 13 cm in one woman. When dissection beyond 7.5 cm laterally or 13.0 cm posteriorly is required, care should be taken to isolate and protect the radial nerve.

Body Height↗
PubMed1988

Heterotopic prosthetic ventricles as a bridge to cardiac transplantation. A multicenter study in 29 patients.

Heterotopic prosthetic ventricles were used to support the circulation in 29 candidates for heart transplantation who were expected to die before procurement of a donor heart. Twenty-one of these patients (average age, 36 years) underwent successful transplantation after 8 hours to 31 days of circulatory support. The other eight patients died because their condition could not be stabilized for transplantation, despite restoration of blood flow. Fourteen patients received biventricular support; 15 received only left ventricular support, with pharmacologic assistance of right heart function. Before transplantation, blood flow from the left prosthetic ventricle averaged 2.8 +/- 0.4 liters per minute per square meter of body-surface area, and from the right prosthesis 2.4 +/- 0.4 liters, as compared with an average flow of 1.6 +/- 0.5 liters per minute per square meter before implantation. Of the 21 patients who received heart transplants, 20 were discharged from the hospital after a median of 31 days. Nineteen patients were alive at 7 to 39 months, and 11 of the first 12 were alive at one year. We conclude that heterotopic placement of prosthetic ventricles as a bridge to transplantation provides an effective method of temporarily supporting cardiac function in critically ill patients without removing the natural heart. The early survival rate after transplantation is similar to that with elective cardiac transplantation.

Adolescent↗