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PubMed1990

Cases of alleged asbestos-related disease: a radiologic re-evaluation.

Chest radiographs were re-evaluated from 439 active and retired tireworkers previously designated as having a condition consistent with an asbestiform mineral exposure. The review was performed in an independent manner by three board-certified radiologists according to guidelines from an international classification system. The percentage of cases with abnormalities consistent with an asbestiform mineral exposure found separately by the three radiologists was 3.7, 3.0, and 2.7%. Application of an algorithm to form a consensus evaluation indicated that approximately 3.6% (16) of the subjects evaluated may have a condition consistent with an asbestos exposure. A more detailed review, however, revealed that only 11 workers, or 2.5% of the total, would have a reasonable likelihood of having such a condition. Most cases were normal and the majority of abnormalities present on the radiographs evaluated were nonoccupational in origin. Prevalent conditions identified included healed tuberculosis, histoplasmosis, emphysema, discoid atelectasis, effusions, healed rib fractures, scarring due to infection or old inflammatory disease, possible cancer, miscellaneous nonspecific linear markings consistent with cigarette smoking and aging, and heart and vascular system diseases--the latter evidenced by an abnormally large number of subjects with healed coronary artery bypass surgery and pacemaker implants. In summary, the best estimate from this study indicates that possibly 16 (3.6%), but more realistically 11 (2.5%), of the 439 tireworkers evaluated may have a condition consistent with exposure to an asbestiform mineral. This represents a 40-fold difference between the re-evaluation results and the original survey work.

Asbestosis↗
PubMed1997

Evaluation of trauma care in a developing country highlighted by a major aircraft accident.

The aim of this study was to evaluate the day-to-day trauma care in a developing country highlighted by a major accident. In this accident, early management was not carried out according to triage principles. Scene mortality and in-hospital mortality were 72% (n = 55) and 14% (n = 3), respectively. Overall mortality rate was 76%. Five survivors were minor wounded. Three laparotomies, one thoracotomy and three tube thoracostomies were performed in the acute phase. Skeletal injuries, mainly rib fractures (43.3%) and haemothorax (10.8%), were the most frequent pathologies seen. One liver laceration, one splenic rupture, one intraabdominal bleeding due to rupture of mesenteric vessels, two major cranial traumas and an abruptio placenta were the other pathologies. The missed injury rate in this accident was 16% (n = 6). It is concluded that the missed injuries in this incident reflect the inadequacy of trauma care in the rural area of the developing country.

Accidents, Aviation↗
PubMed2005

The long-distance tertiary air transfer and care of tsunami victims: injury pattern and microbiological and psychological aspects.

OBJECTIVE: On December 26, 2004, a giant earthquake shocked Southeast Asia, triggering deadly flood waves (tsunami) across the Indian Ocean. More than 310,000 people have been reported dead and millions left destitute. Shortly thereafter, European governments organized airborne home transfer of most severely injured tourists using MedEvac aircraft. On arrival, patients were distributed to various medical centers. One cohort of the severely injured was admitted to the Cologne-Merheim Medical Center (Germany) for further surgical and intensive care treatment. The objective of this report was to characterize typical injury patterns along with microbiological findings and psychoemotional aspects unique to the tsunami disaster. DESIGN: Observational study. SETTING: Adult intensive care unit of a university hospital. PATIENTS: Seventeen severely injured tsunami victims were screened on arrival for characteristic injury patterns. In parallel, multifocal microbiological assessment was performed to identify pathogens responsible for high-level wound contamination. INTERVENTIONS: Standard clinical management. MEASUREMENTS AND MAIN RESULTS: The predominant pattern of injury comprised multiple large-scale soft-tissue wounds (range, 2 x 3 to 60 x 60 cm) of lower extremities (88%), upper extremities (29%), and head (18%). Additional injuries included thoracic trauma with hemopneumothorax and serial rib fractures (41%) and peripheral bone fractures (47%). A major problem associated with wound management was significant contamination. Microbiological assessment identified a variety of common (Pseudomonas 54%, Enterobacteriae 36%, Aeromonas spp. 27%) but also uncommon isolates that were often multiply resistant (multiply resistant Acinetobacter and extended-spectrum beta-lactamase-positive Escherichia coli, 18% each). Upper respiratory tract specimens contained a high rate of multiply resistant Acinetobacter species but also methicillin-resistant Staphylococcus aureus, Aeromonas hydrophilia, Pseudomonas species, and Candida albicans. Apart from these findings, all patients displayed severe signs of posttraumatic stress response. CONCLUSIONS: Individuals who survived their initial injuries and who were evacuated to Europe had traumatic injuries to head, chest, and limbs that were often contaminated with highly resistant bacteria.

Adult↗
PubMed2005

Health burden of pertussis in adolescents and adults.

Pertussis in adolescents and adults is common, endemic, and epidemic worldwide, and its incidence is reportedly increasing. Although a number of individuals suffer only a mild cough, many others have symptoms typical of pertussis, causing prolonged cough illness, frequent use of health care resources, missed work and a variety of complications. Symptoms experienced by adolescents and adults include sleep disturbance, weight loss, pharyngeal discomfort, influenza-like symptoms, sneezing attacks, hoarseness, sinus pain, headaches and sweating attacks. Even when symptoms are typical of pertussis, the diagnosis is often not considered in adolescents and adults because of a low awareness of the disease in these age groups. Contrary to common perceptions, complications of pertussis, including some that are serious, are not infrequent in adolescents and adults. These include urinary incontinence, rib fracture, pneumothorax, inguinal hernia, aspiration, pneumonia, seizures and otitis media. Despite underreporting, hospitalization of adults and adolescents does occur. Many believe that adolescents and adults are the groups most commonly infected with pertussis and are now the major source of contagion to infants and young children. Because of the considerable health burden, there is a need for improved vaccination strategies to prevent disease in adolescents and adults and to reduce the risk of transmission to vulnerable infants.

Adolescent↗
PubMed2004

Analysis of fatal injuries to motorcyclists by helmet type.

To clarify the characteristics of injuries of motorcyclists dying in accidents in relation to helmet type, we retrospectively analyzed forensic autopsies of 36 helmeted motorcycle riders. The presence of major injuries and injury severity were evaluated with the injury severity score and the 1990 revision of the Abbreviated Injury Scale. Persons with open-face helmets (19 cases) were significantly more likely to have sustained severe head and neck injuries, especially brain contusions, than were persons with full-face helmets (17 cases). Furthermore, major injuries of the chest or abdomen, rib fractures, lung injuries, and liver injuries were each present in more than one quarter of all cases (26.3% to 70.6%), but their prevalences did not differ significantly between riders with different types of helmet. Because many types of head and neck injuries cannot be prevented and fatal chest and abdominal injuries occur despite the use of full-face helmets, more effective helmets and devices for protecting the chest and abdomen are needed to decrease deaths from motorcycle accidents.

Accidents, Traffic↗
PubMed2005

Sports-related pneumothorax in children.

Pneumothorax after blunt chest trauma in the absence of rib fractures is uncommon and has only rarely been reported as a result of sporting activity. Presentation may vary from an apparently normal physical examination in the presence of a small pneumothorax to hemodynamic compromise in the presence of a tension pneumothorax. High fitness levels in athletes may result in failure to recognize symptoms and delay diagnosis, potentially increasing morbidity. It is imperative for the emergency physician to exclude pneumothorax in children who present with chest pain after blunt chest trauma from sports injury. We report our experience with and the management of 3 patients with pneumothoraces.

Adolescent↗
PubMed2005

Incidence, risk factors, and outcomes for occult pneumothoraces in victims of major trauma.

BACKGROUND: The supine anteroposterior chest radiograph (CXR) is an insensitive test for posttraumatic pneumothoraces (PTXs). Computed tomographic (CT) scanning often detects PTXs that were not diagnosed on CXR (occult PTXs [OPTXs]). The purpose of this study was to define the incidence, predictors, and outcomes for OPTXs after trauma. METHODS: Thoracoabdominal CT scans and corresponding CXRs of all trauma patients entered into a regional database were reviewed. Patients with OPTXs were compared with those with overt, residual, and no PTXs regarding incidence, demographics, associated injuries, early resuscitative predictors, treatment, and outcomes. RESULTS: Paired CXRs and CT scans were available for 338 of 761 (44%) patients (98.5% blunt trauma). One hundred three PTXs were present in 89 patients, 57 (55%) of which were occult; 6 (11%) were seen only on thoracic CT scan. Age, sex, length of stay, and survival were similar between all groups. OPTXs and PTXs were similar in comparative size index and number of images. Subcutaneous emphysema, pulmonary contusion, rib fracture(s), and female sex were independent predictors of OPTXs. Seventeen (35%) patients with OPTXs were ventilated, of whom 13 (76%) underwent thoracostomy. No complications resulted from observation, although 23% of patients with thoracostomy had tube-related complications or required repositioning. CONCLUSION: OPTXs are commonly missed both by CXR and even abdominal CT scanning in seriously injured patients. Basic markers available early in resuscitation are highly predictive for OPTXs and may guide management before CT scanning. Further study of OPTX detection and management is required.

Adult↗
PubMed1982

Hepatobiliary rickets.

Rickets secondary to hepatobiliary disease is a rare condition; however, the skeletal manifestations are similar to simple nutritional rickets. These skeletal changes include epiphyseal plate abnormalities, pseudofractures, bowing of long bones, scoliosis, and fractures. One-hundred and twelve charts and radiographs of patients with chronic hepatobiliary disease admitted to Children's Hospital of Michigan from 1968 to 1978 were reviewed. Nineteen, or 17%, of these patients showed roentgenographic evidence of rickets. Orthopedic management is primarily concerned with the treatment of fractures and prevention or correction of deformities in those children whose longevity justifies treatment.

Biliary Tract Diseases↗
PubMed2005

Nitric oxide inhalation is useful in the management of right ventricular failure caused by myocardial contusion.

We report a severe head injury and blunt chest trauma with sternal and multiple rib fractures with high-energy impact in a 22-year-old man. Twelve hours after the accident, haemodynamic status of the patient rapidly worsened because of right ventricular (RV) failure due to myocardial contusion, requiring increasing doses of catecholamine. Nitric oxide inhalation was used to decrease RV afterload, and produced an immediate improvement in haemodynamic status, permitting a decrease in catecholamine administration. From days 2 through 8, cardiac function continued to improve, and was normal on day 9. Nitric oxide inhalation was stopped on day 4.

Accidents, Traffic↗
PubMed1987

Transverse disruption of the abdominal wall--a tell-tale sign of seat belt related hollow viscus injury.

A pattern of injuries has been observed in five (5) female front seat passengers wearing seat belts. All were involved in high speed frontal impact motor vehicle accidents on country roads. Varying degrees of abdominal wall disruption involving fat, fascia or muscle, were universally associated with hollow viscus injury and right-sided rib fractures. Most patients had mesenteric or omental tears, flail chests and left clavicular injuries. Intimal tears of the distal aorta, right breast injuries and spinal injuries were also observed. The hollow viscus and mesenteric injuries may result from direct crushing, sudden rises of intraluminal pressure, or shearing forces acting at points of mesenteric attachments. At laparotomy it is recommended that necrotic or contused fascia and muscle be excised with primary abdominal closure and contused fat be excised or curetted and suction drainage applied to the subcutaneous tract. Abdominal wall disruption from seat belt trauma reflects the forces involved on impact and should alert the surgeon to the observed pattern of internal injuries.

Abdominal Injuries↗
PubMed1997

Breast conservation: long-term results from Westmead Hospital.

BACKGROUND: Breast conservation has been shown to be a safe and effective alternative to mastectomy in early-stage breast cancer. The present study reviews the long-term outcome and toxicity after treatment of early breast cancer by conservative surgery and radiation. METHODS: Between November 1979 and December 1989, 438 patients with Union Internationale Contre le Cancer (UICC) stage I or II breast cancer were treated with conservative surgery and radiation therapy (CS+RT) at Westmead Hospital. Surgery to the breast varied from a local excision to a quadrantectomy, depending on the preference of the referring surgeon. The axilla was surgically dissected in 299 patients (68%). All patients received postoperative breast irradiation. The whole breast was irradiated to 46-54 Gy (median dose, 50 Gy) using 6 Mev photons for 5-6.5 weeks. Boosts were given at the primary tumour site in 336 patients (78%), by electron therapy (88 patients), iridium-192 (247 patients) or photons (one patient). A total of 44 patients (10%) received adjuvant chemotherapy. RESULTS: The median follow-up period for surviving patients was 84 months (range: 56-172 months). The 5-year actuarial rate of local recurrence was 6% (312 patients at risk), and the 10-year rate was 10% (52 patients at risk). Very young patients (aged 34 years at diagnosis) had a 5-year actuarial rate of local recurrence of 13% compared to 5% for older patients (P = 0.04). Neither the total dose to the primary site nor the boost technique influenced local recurrence. The 5-year freedom from distant relapse was 83%. The side effects included rib fractures (2%), symptomatic pneumonitis (3%), fatty necrosis or fibrosis requiring surgery (4%), and moderate-severe oedema of the arm (7%). CONCLUSIONS: The long-term data show that CS+RT for UICC stage I or II breast cancer results in low rates of local recurrence which are influenced by age at diagnosis, but not by radiation dose or boost technique. These results confirm those of other international series that CS+RT is a safe alternative to mastectomy for most women with operable breast cancer.

Actuarial Analysis↗
PubMedDate not supplied

A technique for management of bite wounds of the thoracic wall in small dogs.

Bite wounds of the chest wall in small dogs can extend into the thorax and can be associated with severe damage to chest wall muscles, ribs, and lungs. Two major problems associated with the management of these wounds are lack of sufficient muscle tissue for chest wall reconstruction, and difficulty draining the extensive dead space created in the chest wall. We describe a simple method to overcome these problems. The bite wound areas were surgically explored and all devitalized soft tissue was debrided. The pleural cavity was explored, intrathoracic injuries repaired, and a thoracic drainage tube was placed. Ribs in the injured area were stabilized in anatomic position by means of heavy gauge sutures passed around pairs of adjacent ribs, thus creating a scaffolding for soft tissues. Viable muscle and subcutaneous tissues were apposed as much as possible and the skin closed over the defect. Eleven small dogs were treated using this technique. All dogs had severe injuries to the thoracic wall muscles and eight dogs had multiple rib fractures. There was no evidence of chest wall instability in any of the dogs after surgery. Nine dogs survived the injury and were reevaluated 3 to 32 months after surgery. All were clinically normal. One dog developed wound infection and pyothorax, caused by insufficient debridement of injured muscle tissue, and died 10 days after surgery. A second dog died 24 hours postoperatively of undetermined causes.

Animals↗
PubMed2004

Gastrocutaneous fistula as a result of migration of a foreign body in a dog.

A six-year-old, female Tibetan terrier was referred for investigation of a non-healing wound on the left caudal thorax. A subcutaneous swelling had initially developed on the chest wall, followed by a draining tract from which seropurulent fluid drained for two months. There had been no response to antibiotic treatment. Following radiographic and ultrasonographic examinations, a bone sequestrum from a fractured rib or a foreign body was suspected. Surgical exploration of the wound identified a sinus tract and a wooden foreign body (an ice-lolly stick) was located in subcutaneous tissues. Partial wound dehiscence of the surgical site occurred postoperatively, but healed after 10 days. One month later, fluid began to discharge from the area again. Further surgical exploration confirmed a gastrocutaneous fistula. Dissection of the fistula and surgical closure of the stomach, body wall and skin led to resolution of all signs.

Animals↗
PubMed2006

Thoracic bite trauma in dogs: a comparison of clinical and radiological parameters with surgical results.

OBJECTIVES: Canine bite wounds may cause severe underlying tissue trauma even with no clinically evident puncture wounds. In order to assess the ability of pre-operative diagnostic parameters to predict the extent of internal damage inflicted by a thoracic bite wound, the clinical, radiological and surgical data of 45 dogs that sustained thoracic bite trauma were recorded. METHODS: Clinical, radiographic and surgical parameters from 45 dogs of various breeds with thoracic bite trauma, were analysed (P<0.05). All dogs were treated according to a previously described protocol and had exploratory surgery including a thoracotomy. RESULTS: Mainly small-breed dogs were traumatised. Clinical and radiological data were suggestive of internal trauma but not reliable as accurate indicators for internal lesions. Only radiological evidence of lung contusion was significantly associated with the presence of surgically confirmed lung contusion (P=0.006). Dogs with postoperative wound complications had a significantly higher risk of dying than those without complications (P=0.04). CLINICAL SIGNIFICANCE: This study concludes that according to protocol an optimal management of thoracic bite wounds in small dogs includes surgical exploration of the wound and the thoracic cavity in the presence of flail or pseudo-flail chest, fractured ribs, radiological evidence of lung contusion, pneumothorax or any combination of these.

Animals↗
PubMed1975

Meningeal haemorrhage and congestion associated with the perinatal mortality of beef calves.

Thirty Angus, Hereford and Shorthorn term calves dying before, during or within 7 days of birth in a large beef herd were autopsied. Selected specimens were examined histologically. Two carcasses were classified in the category of ante-parturient death, 24 as parturient, and 4 were classified in the post-parturient death category. Three of the latter showed evidence of starvation. Eight of the calves in the parturient death category were assisted during delivery, and 16 were not assisted. The incidence of nulliparous dams among assisted parturient deaths was significantly higher than among the unassisted group. A high incidence of meningeal haemorrhages and congestion were observed at single or multiple sites, within and around the cranial and spinal meninges. The lesions comprised subdural and epidural haemorrhages, bloodstained cerebrospinal fluid and leptomeningeal haemorrhage and congestion. They were seen in calves in both parturient and post-parturient death categories but not in the ante-parturient group. All calves classified in the parturient death category which were assisted during delivery showed haemorrhages involving the cranial and/or spinal meninges. Additional birth injuries, including separation of the costo-chondral junctions, fractured ribs, haemorrhage into the hip joints, inter-vertebral fibrocartilages and axillae, and rupture of the liver, were frequently present. Ten of the calves in the parturient death category which were unassisted during delivery showed meningeal haemorrhage and congestion. Two of the 4 calves in the post-parturient death category showed similar lesions and both showed evidence of starvation. The meningeal haemorrhages and congestion were similar to those observed in perinatal lamb mortality. They are considered manifestations of injury to the CNS arising from trauma and/or hypoxia during birth. Gross or microscopic evidence of infection was present in 2 calves in the post-parturient death category. Calves which had starved showed subcutaneous oedema of the distal limbs, congestion and focal haemorrhage of the adrenal cortex and red-brown fat depots. It is suggested that these changes are evidence of cold injury, and that fat in newborn calves responds to cold and starvation in a manner similar to the brown fat of newborn lambs.

Adipose Tissue↗
PubMed1983

Heritable bone fragility, joint laxity and dysplastic dentin in Friesian calves: a bovine syndrome of osteogenesis imperfecta.

A lethal syndrome of bone fragility, joint laxity, translucent teeth and other connective tissue defects occurred in Victoria in 37 of 84 progeny of a clinically normal, registered Friesian bull between 1978 and 1981. Test matings to unrelated cows indicated that the syndrome was transmitted as an autosomal dominant trait. Affected calves were readily recognized at birth by pink teeth and abnormal posture. At birth 14 of 19 affected calves examined had rib fractures and 4 of these calves also had fractures of long bones. Spontaneous fractures of long bones also occurred in 5 of the 11 calves which survived for more than 10 days. Hypoplasia of dentin, tendons, and ligaments were observed in all cases at necropsy. Osteopenia was only observed at necropsy in older calves. Histological lesions of bone and teeth were similar to those reported in descriptions of osteogenesis imperfecta with dentinogenesis imperfecta in man. The syndrome is provisionally designated as "bovine osteogenesis imperfecta". Semen has been collected from the progenitor bull to enable further investigations of this heritable collagenous tissue dysplasia.

Animals↗
PubMed1995

Thoracic deformation and velocity analysis in frontal impact.

The objective of the present study was to measure dynamic chest deformations and compute chest velocity and viscous criterion during real world frontal impacts conducted on a horizontal sled. Four unembalmed human cadavers were restrained using a three-point belt restraint in the driver seat of a sled buck. Two chest bands (each with a 24 gauge capability) were placed on the thorax to record the temporal deformation patterns during impact. All tests were conducted at a velocity of approximately 50 kph. Biomechanical data were gathered digitally at a sampling rate of 12,500 Hz. Multiple rib fractures were identified in all specimens at autopsy. Analysis of approximately 800 temporal deformation contours of the thorax demonstrated regional differences. The overall mean maximum normalized chest deflections, maximum chest compression velocities, and peak viscous response variables ranged from 0.15 to 0.51, 1.79 to 4.87 m/s, and 0.15 to 1.95 m/s, respectively. These findings clearly illustrate the potential use of the chest band output to correlate injury with biomechanical variables and establish thoracic impact tolerance.

Accidents, Traffic↗