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PubMed2005

Can external signs of trauma guide management?: Lessons learned from suicide bombing attacks in Israel.

BACKGROUND: Following a suicide bombing attack, scores of victims suffering from a combination of blast injury, penetrating injury, and burns are brought to local hospitals. OBJECTIVE: To identify external signs of trauma that would assist medical crews in recognizing blast lung injury (BLI) and effectively triaging salvageable and nonsalvageable victims. DESIGN: Retrospective analysis of all 15 suicide bombing attacks that occurred in Israel from April 1994 to August 1997. SETTING: National survey. PATIENTS: One hundred fifty-three victims died and 798 were injured as a result of 15 attacks. Medical records were reviewed for external signs of trauma, such as burns and penetrating injuries, and the presence of BLI. Main Outcome Measure The odds ratio for BLI and death. RESULTS: Three settings were targeted: buses, semiconfined spaces, and open spaces. Sixty survivors (7.5%) suffered from BLI, which was more common in buses (37 of 260) than semiconfined spaces (14 of 279) and open spaces (9 of 259) (P<.001). Victims with BLI were more likely to suffer from penetrating injury to the head or torso, burns covering more than 10% of the body surface area, and skull fractures (odds ratios, 4, 11.6, and 55.8, respectively; P<.001). Victims who died at the scene were more likely to suffer from burns, open fractures, and amputations in comparison with survivors (odds ratios, 6.5, 18.6, and 50.1, respectively; P<.001). CONCLUSIONS: Following a suicide bombing attack, external signs of trauma should be used to triage victims to the appropriate level of care both at the scene and in the hospital. Triage of salvageable and nonsalvageable victims should take into account the presence of amputations, burns, and open fractures.

Adolescent↗
PubMed1996

Climbing, brachiation, and terrestrial quadrupedalism: historical precursors of hominid bipedalism.

The vertical-climbing account of the evolution of locomotor behavior and morphology in hominid ancestry is reexamined in light of recent behavioral, anatomical, and paleontological findings and a more firmly established phylogeny for the living apes. The behavioral record shows that African apes, when arboreal, are good vertical climbers, and that locomotion during traveling best separates the living apes into brachiators (gibbons), scrambling/ climbing/brachiators (orangutans), and terrestrial quadrupeds (gorillas and chimpanzees). The paleontological record documents frequent climbing as an ancestral catarrhine ability, while a reassessment of the morphology of the torso and forelimb in living apes and Atelini suggests that their shared unique morphological pattern is best explained by brachiation and forelimb suspensory positional behavior. Further, evidence from the hand and foot points to a terrestrial quadrupedal phase in hominoid evolution prior to the adoption of bipedalism. The evolution of positional behavior from early hominoids to hominids appears to have begun with an arboreal quadrupedal-climbing phase and proceeded though an orthograde, brachiating, forelimb-suspensory phase, which was in turn followed by arboreal and terrestrial quadrupedal phases prior to the advent of hominid bipedality. The thesis that protohominids climbed down from the trees to become terrestrial bipeds needs to be reexamined in light of a potentially long history of terrestriality in the ancestral protohominid.

Animals↗
PubMed1996

Is there a cocaine syndrome? Dysmorphic and anthropometric assessment of infants exposed to cocaine.

It was suggested that a "fetal cocaine syndrome" exists. The objective of this study was to systematically investigate whether or not a "cocaine syndrome" exists. The setting was Parkland Memorial Hospital, a large urban public hospital in Dallas, TX, where approximately 15,000 infants are delivered annually. Infants who tested positive by urinalysis for cocaine (n = 25) were included in this study. Controls negative for cocaine (n = 25) were matched to cocaine-exposed infants for estimated gestational age, sex, and race. A standardized dysmorphology examination (135 features) and a series of anthropometric measures (n = 22) were done for each cocaine-exposed and control infant by an observer blinded to drug-exposure status. Fetal growth retardation characterized cocaine-exposed infants. No characteristic pattern of minor dysmorphic or anthropometric features of the face, limbs, or torso was observed among cocaine-exposed infants. Cocaine-exposed infants lack a facial gestalt or torso/limb features that would characterize a syndrome. If a "cocaine syndrome" that can be characterized dysmorphologically and/or anthropometrically exists, its occurrence seems infrequent.

Abnormalities, Drug-Induced↗
PubMed1997

Effects of TCDD on Ah receptor, ARNT, EGF, and TGF-alpha expression in embryonic mouse urinary tract.

Prenatal exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) induces hydronephrosis in C57BL/6N mice. The etiology of this response involves TCDD-induced hyperplasia of ureteric epithelium, which occludes the ureteric lumen, blocking the flow of urine. The present study localizes and examines the effects of TCDD on the expression of the Ah receptor (AhR), the Ah receptor nuclear translocator (ARNT), epidermal growth factor (EGF), and transforming growth factor-alpha (TGF-alpha) in the epithelial cells of the developing urinary tract, particularly the ureteric bud derivatives (ureter and tubules). Pregnant C57BL/6N mice were dosed on gestation day (GD) 10 with either corn oil or TCDD at 12 micrograms/kg; a dose of 24 micrograms/kg is expected to induce 100% hydronephrosis. The metanephric urinary tract is morphologically detectable as early as GD 12; thus, embryos were removed on GD 12, 13, and 14, and the lower dorsal torso was prepared for immunohistochemistry or in situ hybridization. Regardless of treatment, the expression of both AhR and ARNT increased in epithelial cells of the ureter and AhR increased in the metanephric tubules from GD 12-14. In situ hybridization localized the expression of AhR and ARNT mRNAs to these derivatives of the ureteric bud and levels of mRNA increased throughout the developmental period examined. There were no significant effects of TCDD treatment on expression of AhR, while TCDD significantly decreased levels of ARNT in tubules on GD 14. The epithelial cells of the ureter and tubules expressed TGF-alpha and EGF. EGF increased from GD 12 to 13 in the tubules and ureter, but there was no difference from GD 13 to 14. Treatment with TCDD reduced TGF-alpha significantly only in tubules on GD 13. TCDD exposure significantly decreased EGF in ureter and tubule cells on both GD 13 and 14. In summary, the epithelial cells of the embryonic mouse urinary tract expressed AhR, ARNT, EGF, and TGF-alpha in developmentally dependent patterns. These proteins are involved in the regulation of embryonic cell proliferation during normal urinary tract development and are probably involved in the hyperplastic response to TCDD.

Animals↗
PubMed1999

Resistive homogeneous MRI magnet design by matrix subset selection.

A new technique for designing resistive homogeneous multicoil magnets for magnetic resonance imaging (MRI) is presented. A linearly independent subset of coils is chosen from a user-defined feasible set using an efficient numerical algorithm. The coil currents are calculated using a linear least squares algorithm to minimize the deviation of the actual magnetic field from the target field. The solutions are converted to practical coils by rounding the currents to integer ratios, selecting the wire gauge, and optimizing the coil cross-sections. To illustrate the technique, a new design of a short, homogeneous MRI magnet suitable for low-field human torso imaging is presented. Magnets that satisfy other constraints on access and field uniformity can also be designed. Compared with conventional techniques that employ harmonic expansions, this technique is flexible, simple to implement, and numerically efficient.

Algorithms↗
PubMed2000

Validation of MR-based polymer gel dosimetry as a preclinical three-dimensional verification tool in conformal radiotherapy.

The aim of this work was to investigate MR-based polymer gel dosimetry as a three-dimensional (3D) dosimetry technique in conformal radiotherapy. A cylindrical container filled with polymer gel was placed in a water-filled torso phantom to verify a treatment plan for the conformal irradiation of a mediastinal tumor located near the esophagus. Magnetic resonance spin-spin relaxation rate images were acquired and, after calibration, converted to absorbed dose distributions. The dose maps were compared with dose distributions measured using radiographic film. The average root-mean-square structural deviation, for the complete dose distribution, amounted to less than 3% between gel and film dose maps. It may be expected that MR gel dosimetry will become a valuable tool in the verification of 3D dose distributions. The influence of imaging artifacts arising from eddy currents, temperature drift during scanning, and B1 field inhomogeneity on the dose maps was taken into account and minimized.

Acrylamide↗
PubMed1977

Soft part tumors.

Results of management of rhabdomyosarcoma of childhood have improved in a dramatic manner during the recent 10 years as a consequence of the treatment by three modality approach which relies on an intensive multi-drug multicycle chemotherapy regimen combined with radiation therapy and or surgery. Both local results and total disease-free survival rates are markedly better with this more comprehensive approach. A staging system for sarcoma of soft tissue has just been developed by the A.J.C. Histopathological grade is the important parameter: stage 1,2, and 3 are tumors of histological grades 1, 2, and 3 respectively (an outline of the system is presented). Treatment results of 100 patients with sarcoma of soft tissue (extremities 89, torso 11) treated by radical dose radiation therapy (less than 6300 rad) and limited surgery at M.D. Anderson Hospital are presented. For both local control and disease free survival, results decreased with advancing stage and anatomic site was not a factor per se. Radiation therapy under tourniquet induced hypoxia was not found to be significantly more effective than conventional radical dose therapy. The necessity of planning treatment such that if subsequent surgery is required, the fields will provide the best distribution of unirradiated or low dose tissue for preparation of flaps, etc.

Adult↗
PubMed1980

Laparotomy staged I and II non-Hodgkin's lymphomas: preliminary results of radiotherapy and adjunctive chemotherapy.

Fifty-three non-Hodgkin's lymphoma patients staged I, IE, II, and IIE after laparotomy, received involved field radiotherapy with or without adjunctive chemotherapy. These cases have been analyzed for survival, disease-free survival, sites of relapse, and subsequent management. For nodular lymphoma patients, the five-year survival figure was 87%. While this represents only modest improvement over survival figures for patients staged I and II by lymphangiography, results for patients with upper torso disease were significantly better. Although there was a definite incidence of relapse, early failures common in the lymphangiogram series, were not seen in this study. Of the total group of 14 patients, 4 relapsed after a minimum complete remission period of 20 months. The five-year survival figure for all presentations of stages I and II diffuse histiocytic lymphoma was 85%. This represents a substantial improvement over the corresponding figure of 36% for patients staged clinically after lymphangiography. The improvement in results is credited to more precise staging of patients with peripheral presentations, the use of adjunctive multiple-agent chemotherapy for abdominal and mediastinal presentations, and more effective treatment for relapse. To date, too few patients with peripheral presentations have been treated to determine the value of adjunctive chemotherapy for nodular or diffuse histiocytic patients.

Aged↗
PubMed2005

Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma.

BACKGROUND: Ultrasonography is regarded as the tool of choice for early diagnostic investigations in patients with suspected blunt abdominal trauma. Although its sensitivity is too low for definite exclusion of abdominal organ injury, proponents of ultrasound argue that ultrasound-based clinical pathways enhance the speed of primary trauma assessment, reduce the number of computed tomography scans and cut costs. OBJECTIVES: To assess the efficiency and effectiveness of trauma algorithms that include ultrasound examinations in patients with suspected blunt abdominal trauma. SEARCH STRATEGY: We searched MEDLINE, EMBASE, CENTRAL, CCMED, publishers' databases, controlled trials registers and the Internet. Bibliographies of identified articles and congress abstracts were handsearched. Trials were obtained from the Cochrane Injuries Group's trials register. Authors were contacted for further information and individual patient data. SELECTION CRITERIA PARTICIPANTS: patients with blunt torso, abdominal or multiple trauma undergoing diagnostic investigations for abdominal organ injury. INTERVENTIONS: diagnostic algorithms comprising emergency ultrasonography (US). CONTROLS: diagnostic algorithms without US ultrasound examinations (e.g. primary computed tomography [CT] or diagnostic peritoneal lavage [DPL]). OUTCOME MEASURES: mortality, use of CT and DPL, cost-effectiveness, laparotomy and negative laparotomy rates, delayed diagnoses, and quality of life. STUDIES: randomised controlled trials (RCTs) and quasi-randomised trials (qRCTs). DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion, assessed methodological quality and extracted data. Where possible, data were pooled and relative risks (RRs), risk differences (RDs) and weighted mean differences, each with 95% confidence intervals (CIs), were calculated by fixed- or random-effects modelling, as appropriate. MAIN RESULTS: We identified two RCTs with US in the experimental arm and another with US in the control group. We also considered two qRCTs. Overall, trials were of moderate methodological quality. Few authors responded to our written inquiries seeking to resolve controversial issues and to obtain individual patient data. We were able to pool data from two trials comprising 1037 patients for primary endpoint analysis (i.e. mortality). The relative risk in favour of the no-US arm was 1.4 (95% CI 0.94 to 2.08). Because of a lack of details, the meaning of this observation remains unclear. There was a marginal benefit with US-based pathways in reducing CT scans (random-effects RD -0.46; 95% CI -1.00 to 0.13), offset by trials of higher methodological rigour. No differences were observed in DPL and laparotomy rates. AUTHORS' CONCLUSIONS: There is insufficient evidence from RCTs to justify promotion of ultrasound-based clinical pathways in diagnosing patients with suspected blunt abdominal trauma.

Abdominal Injuries↗
PubMed2000

Effects of an increased air gap on the in vitro interaction of wireless phones with cardiac pacemakers.

Several clinical and laboratory studies have demonstrated electromagnetic interaction between implantable cardiac pacemakers and hand-held wireless phones operated in close proximity. Current FDA and HIMA labeling guidelines indicate that a minimum separation of 6 in (15 cm) should be maintained between a hand-held wireless phone and an implanted pacemaker. This separation requirement does not distinguish between lateral locations on the chest and a perpendicular air gap. Evidence is provided here for a substantially reduced separation threshold when measured across an air gap rather than near the saline conductive media of a simulated torso. Twenty pacemaker-phone combinations involving 6 pacemakers and 9 phones were evaluated in vitro under worst-case conditions with respect to phone output power and pacemaker sensitivity. The phones represented CDMA, TDMA-11 Hz, TDMA-22 Hz, TDMA-50 Hz, and TDMA-217 Hz digital wireless technologies. Small increases in the perpendicular air gap between the phone and the saline surface resulted in a dramatic reduction in interaction. Approximately half of the 208 test runs exhibiting interaction at an air gap of 1 cm no longer resulted in interaction when the gap was increased to 2 cm. At a gap of 7.4 cm, the percentage of runs with interaction decreased to 1.4%. The overall interaction rate, considering a total of 8296 test runs from an earlier study, was less than 0.07% at a total perpendicular distance of 8.6 cm from the saline surface to the phone antenna axis. The perpendicular distance threshold of 8.6 cm was significantly less than the horizontal plane projection threshold of 19 cm previously reported. This difference is a function of the electromagnetic field coupling to the saline bath rather than field strength changes along the axis of the phone antenna. The results have implications for those making recommendations to pacemaker patients who may be unaware of this distinction.

Air↗
PubMed2001

Different ways to make a head.

In Drosophila, the establishment of the larval head and thorax depends on the transcription factors BICOID and HUNCHBACK, and on signalling mediated by the receptor tyrosine kinase TORSO. Genetic experiments described in two recent papers(1, 2) demonstrate that these factors can, to a large extent, replace each other, revealing a surprising degree of plasticity in establishing larval anterior structures. The commutability of developmental factors might in part reflect the evolutionary history of the system. BioEssays 23:8-11, 2001.

Animals↗
PubMed1999

Movement disorders in Kuru.

OBJECTIVE: To describe the gamut of movement disorders (MD) seen during the clinical course of kuru. BACKGROUND: Kuru is a subacute spongiform encephalopathy that was confined to several adjacent cultures in the Eastern Highlands of New Guinea and resulted from contamination with brain tissue during the ritual endocannibalism practiced in those societies. This unique neurologic disease was recorded extensively with film between 1957 and 1976, and these comprehensive research documents have been donated to the American Academy of Neurology archives by one of the authors (DCG). METHODS: The comprehensive assembly of film record of kuru, which was collected by one of the authors (DCG) was reviewed. This comprised two parts: The first were films from 1957-1964 and included 17.397 ft of 16-mm film featuring 204 patients (children and adults); the second is assembled from films made from 1967-1976 and includes 9138 ft. of film featuring 47 adult patients. Two MD specialists categorized all MDs observed and a representative videotape was produced. RESULTS: Tremor is the most frequently encountered MD in kuru and is typically of the action/intention type, which appears early in the disease and is soon associated with other clinical signs of cerebellar dysfunction. Widespread clonus is characteristic of advanced disease and can be difficult to differentiate from tremor. Dystonia/athetosis and choreiform jerks also appear as the disease progresses. Dystonia can involve the torso, distal limbs, neck, or jaw. Myoclonic jerks can be superimposed on the cerebellar or dystonic features usually with an enhanced startle response. Parkinsonian symptomatology, other than resting tremor is frequent among the filmed subjects especially in the second stage of the disease. CONCLUSION: The clinical manifestations of kuru involved a wide array of MDs during all three stages of the degenerative illness.

Adult↗
PubMed1990

Role of receptor tyrosine kinases during Drosophila development.

In vertebrates, a tyrosine kinase activity has been identified as an integral component of growth factor receptors and the products of proto-oncogenes. Many of these receptor tyrosine kinases (RTKs) appear to play a key role in the regulation of cell growth. Recent analyses of several Drosophila genes encoding putative RTKs indicate that this class of proteins also plays an important role in decisions about cell fate that depend on cellular interactions during development. The sevenless RTK mediates the position-dependent specification of a particular photoreceptor cell type (R7) in the eye. The local specification of R7 cells requires a functional tyrosine kinase domain of the sevenless protein but does not depend on the spatially restricted expression of the sevenless gene. The Drosophila EGF receptor homologue serves multiple functions during development, some of which are clearly unrelated to regulation of cell growth. Finally, the torso gene encodes an RTK required for the specification of the terminal regions of the Drosophila larva. A number of other genes have been genetically identified that appear to function in the same developmental processes upstream or downstream of these three RTKs. These loci are excellent candidates for genes encoding other components of the signalling pathways, such as ligands or substrates of the RTKs.

Alleles↗
PubMed1994

Genetics of nanos localization in Drosophila.

The Drosophila gene nanos is required for two processes. During oogenesis, nanos function is required for the continued production of egg chambers, and nanos is expressed in the early germarium. During embryogenesis, nanos is required maternally to specify abdominal segmentation. Nanos shares this latter function with nine other genes, collectively known as the posterior group. Of this group, nanos encodes a determinant, and is localized as an RNA to the posterior pole of early embryos. This RNA is translated to form a gradient of nanos protein with highest concentrations at the posterior. Analysis of the distribution of nanos gene products in embryos mutant for posterior group genes shows that eight of these genes are required for localization, but not stability, of the nanos RNA. Embryos mutant for posterior group alleles which produce weak abdominal phenotypes show reduced amounts of localized nanos RNA. This correlation between nanos RNA localization and abdominal phenotype suggests that nanos acts as a localization-dependent posterior determinant. Localization of nanos is not affected by mutations in bicoid or torso, confirming that the three maternal systems of anterior-posterior determination initially act independently.

Alleles↗
PubMedDate not supplied

Prenatal smoke exposure alters growth in limb proportions and head shape in the midgestation human fetus.

The objective of this study was to examine the effects of smoke exposure on the growth patterns of the head, limbs, and torso of the midgestation human fetus. Four hundred maternal/fetal pairs contributed to this analysis: 366 individuals were assessed cross-sectionally (87 smokers and 279 nonsmokers) at approximately 20 and 32 weeks, and 34 individuals were followed longitudinally at 23, 27, and 32 weeks (10 smokers, 24 nonsmokers). Ten body parameters were measured by fetal ultrasound. In both samples, controlling for day of measurement, smoke exposure was significantly associated with early growth acceleration in head and abdominal diameters at 20-27 weeks (P < 0.05). This was followed by altered head shape (a significantly smaller biparietal to occipital frontal diameter ratio at 32 weeks, P < 0.01), and a proximal/distal growth gradient as proportionately long arms (P < 0.05 at 27 and 32 weeks) and short legs were apparent by 32 weeks, with a significant reduction in the tibia/femur ratio (P = 0.04). These fetal body growth patterns, expressed in terms of size and proportionality, are consistent with the presence of chronic hypoxia associated with maternal smoking. The growth pattern differences identify that prenatal smoking is not merely an insult resulting in consistent size and growth rate reduction across developmental ages. Instead, smoke exposure alters the growth rate of individual body segments at variable developmental stages as the fetus experiences selective growth restriction and augmentation. We hypothesize that the growth patterns observed here reflect the unique pattern of fetal blood flow favoring upper body oxygen distribution and extraction, together with genetically based adaptive strategies that permit the fetus to adjust the timing and magnitude of its growth to local environmental resources. It is possible that dolichocephaly is a previously unappreciated marker of fetal hypoxia. Reduced tibial growth may be a good marker for shortfall and a useful proxy for the adequacy of circulating resources more generally.

Anthropometry↗
PubMed1993

Early surgical management of severe forms of osteogenesis imperfecta.

The early surgical management of severe osteogenesis imperfecta (OI) was studied in three children with autosomal recessive type III form of this disease. Each child had similar clinical and radiographic features at birth. The spine, pelvis, and thorax were osteoporotic but were well formed and free of major fractures. In contrast, the peripheral skeleton was severely affected with numerous new and old fractures. Conservative treatment of fractures was undertaken with a foam mould for the torso and limbs and additional support was provided for specific unstable painful fractures. However, fractures continued due to the extreme bone fragility and deformities. Surgical correction of deformities and internal splinting of the long bones with intramedullary rods was commenced between 18 months and 5 years of age. The shafts of the long bones were extremely fragile and lacked cortical bone. The osteotomies were undertaken with a scalpel. The fracture rate diminished rapidly but the non-extending rods needed shortening or replacing within 2 to 3 years. The combination of external and internal fixation and electric wheel chairs greatly reduced the frequency of fractures and facilitated the general care and development of these 3 children with a severe form of OI.

Female↗
PubMed1983

Multiple discriminant function analysis of sex and race in the postcranial skeleton.

Terry Collection femora and innominates of 260 American Whites and Blacks (65 males and 65 females of each race) were analyzed by multiple discriminant function analysis. A stepwise procedure produced three optimal discriminant functions using 15 of our 32 measurements. These functions correctly identified 95% of the sample. The first two-one for sex and one for race-are statistically and biologically significant and form the basis of our analysis. The sexing function manifested both size and shape elements. Prominent among the former was joint size--acetabular diameter and epicondylar diameter of the femur. The shape elements included form of the greater sciatic notch and of the inferomedial aspect of the pubic body. The racing function highlighted a pattern of greater innominate dimensions, exclusive of the acetabular joint, in Whites. This was in contrast to the greater length of the Black femur. Overall, the function seems to express the established differences between the races in the ratio of lower limb length to torso length. While these functions have been applied successfully to forensic cases with confirmed identifications, questions regarding the breadth of applicability of discriminant functions make it desirable to validate our results on new material from the Terry and other collections.

Analysis of Variance↗
PubMed1993

Partial skeleton of Proconsul nyanzae from Mfangano Island, Kenya.

A partial skeleton attributed to Proconsul nyanzae (KNM-MW 13142) is described. The fossils were found at a site on Mfangano Island, Kenya, which dates to 17.9 +/- .1 million years ago. KNM-MW 13142 consists of six partial vertebrae (T12-S1), a nearly complete hipbone, most of the right femur and left femoral shaft, a fragmentary tibia and fibula, and a nearly complete talus and calcaneus. This skeleton provides the first pelvic fossil known for any East African Miocene hominoid. The new Proconsul specimen is compared to a large sample of extant anthropoids to determine its functional and phylogenetic affinities. In most aspects of its anatomy, KNM-MW 13142 closely resembles nonhominoid anthropoids. This individual had a long, flexible spine, narrow torso, and habitually pronograde posture, features characteristic of most extant monkeys. Evidence of spinal musculature suggests a generalized condition intermediate between that of cercopithecoids and hylobatids. The hindlimb of KNM-MW 13142 exhibits relatively mobile hip and ankle joints, with structural properties of the femur like those of hominoids. This mix of features implies a pattern of posture and locomotion that is unlike that of any extant primate. Many aspects of the Proconsul nyanzae locomotor skeleton may represent the primitive catarrhine condition.

Animals↗