The art of getting published.

Getting academic research published can be a daunting undertaking at first, and before the advent of academic junior doctor posts, was a hidden art for most. Publications remain an important milestone in academic progress in many disciplines and in some medical specialties are a prerequisite for selection to higher training grades. This article provides a brief overview of some of the issues facing those wishing to publish and how they may be overcome.

Prolonged permissive hypotensive resuscitation is associated with poor outcome in primary blast injury with controlled hemorrhage.

OBJECTIVE: To determine the effects of primary blast injury (PBI) on survival and the physiological response to resuscitation after hemorrhagic shock. BACKGROUND: Air-blast injury is a significant clinical problem that can reduce blood oxygenation and modify the response to hemorrhage. PBI has specific physiological effects that have not been fully accounted for in resuscitation strategies. Permissive hypotension is a widely adopted strategy in trauma resuscitation. However, the choice of resuscitation strategy requires a full understanding of the mechanisms of injury and their physiological consequences. METHODS: Terminally anesthetized pigs were divided into 4 groups and subjected to either air-blast injury (B) or no blast (S). All received a controlled hemorrhage of 30% blood volume and resuscitation with 0.9% saline to a normotensive (Normot, systolic blood pressure 110 mm Hg) or hypotensive (Hypot, 80 mm Hg) end point for up to 8 hours. (n = 6 in each B and n = 8 in each S subgroup). RESULTS: Survival time was significantly shorter with Hypot (P < 0.0001 Peto log rank). The effect was in the animals subjected to B (P = 0.0005) (mean survival time [95% CI]; BNormot 422 [313-531] vs. BHypot137 [94-181] min), but not those given S (P = 0.06) (SNormot 480 [all survived] vs. SHypot 352 [210-494] min). PBI exacerbated a profound metabolic acidosis during Hypot, possibly due to an overwhelming compromise in tissue oxygen delivery. CONCLUSIONS: Prolonged hypotensive resuscitation is not compatible with survival after primary blast. Casualties most likely to be in this category are those injured by blast in confined spaces or by enhanced blast weapons. The risk of rebleeding associated with normotensive resuscitation needs to be balanced with the metabolic derangement associated with hypotensive resuscitation.

Intra-abdominal injury from extra-peritoneal ballistic trauma.

Over the last century sporadic reports have described intra-abdominal injury without penetration of the abdominal cavity but the underlying mechanism of energy transfer appears variable. This article reviews the 19 documented cases of this phenomenon and discusses the mechanism of energy transfer in both primary blast injury and ballistic injury that may be responsible.

Adenocarcinoma of a colostomy following abdominoperineal resection for squamous cell carcinoma of the anal canal: a case study.

Malignant neoplasms presenting on a stoma, as well as the development of colorectal adenocarcinoma after previous treatment for squamous cell carcinoma (SCC) of the anal canal, are rare. The unique case is presented of an 81-year-old woman with parastomal bleeding and ulceration found to have a primary colorectal adenocarcinoma arising de novo on a colostomy, formed after salvage abdominoperineal resection (APR) 3 years earlier for recurrent anal SCC. This is the first reported case of a colonic adenocarcinoma on a colostomy formed after an APR for anal SCC. Although stomal neoplasia is rare, the appearance of a friable bleeding lesion on the stoma should be investigated to exclude metastatic cancer or a second primary malignancy.

Mechanisms of injury by explosive devices.

Explosive devices cause injury by four mechanisms, of which primary blast injury is the least familiar to most non-military clinicians. The pathophysiology of the various mechanisms of injury is described, and the implications for translating a knowledge of mechanism of injury to clinical management is discussed.

Extradural cord compression due to metastatic oligodendroglioma.

Extraneural metastases from primary intracranial tumours are extremely rare. We present a case of metastatic oligodendroglioma causing extradural spinal cord compression at the level of the sixth thoracic vertebrae resulting in paraplegia. We discuss the routes of tumour dissemination and possible reasons for the rarity of cases of metastatic oligodendroglioma.