Diagnostic value of abdominal follow-up sonography in polytrauma patients: A retrospective study.

In many German trauma centres, it is routine to perform abdominal follow-up sonography (AFS) 6 h after admission for patients with multiple trauma, even if the clinical course is uneventful and multi-slice computed tomography (MSCT) reveals no abdominal pathology. However, this approach is not recommended in the German Guidelines for trauma, and recent studies have questioned the value of AFS to these patients. The present study aimed to evaluate the revised German Guidelines for trauma with respect to the omission of AFS.We included patients with multiple injuries with no clinical signs of abdominal trauma and with normal abdominal MSCT. We collected clinical data of 370 consecutive patients who underwent AFS (Group A) and another 370 consecutive patients who did not undergo AFS (Group B).No abdominal injury was missed by the omission of AFS, and thus, no patient suffered from its omission or benefitted from the use of AFS. In our study population, the negative predictive value of normal MSCT results combined with no clinical signs of abdominal trauma was 100% (95% confidence interval: 99.5%-100.0%).This single-centre study conducted in a large German trauma centre demonstrates AFS to have no utility in the diagnosis of abdominal injury. Moreover, omission of AFS for conscious patients without clinical signs of abdominal trauma and with negative abdominal MSCT does not appear to have negative consequences in terms of missed abdominal injury.Therefore, AFS can be safely omitted in the majority of cases of polytrauma, which simplifies the imaging workup tremendously.

Paget's disease in the head and neck.

This paper presents a survey of manifestations of Paget's disease, osteitis deformans of the head and neck. The pathology and pathogenesis of the disease are considered and the clinical manifestations examined in relation to the area of the skull involvement, outlining ocular, auditory, vestibular, dental and general manifestations.

Effects of a single dose of loratadine on flying ability under conditions of simulated cabin pressure.

Pilots with allergic diseases, who need antihistaminic drug therapy, have to be grounded temporarily because this therapy is considered to interfere with flight safety due to its sedative effects. There is evidence that loratadine is practically void of these sedative effects, and therefore might be prescribed to pilots. A study was conducted to determine the effects of loratadine on performance and alertness. In a randomized, double-blind, within subjects design, 18 male subjects were studied, employing loratadine 10 mg, triprolidine hydrochloride 5 mg, and placebo. Objective (vigilance, complex tasks) and subjective tests, tailored to the specific tasks of aircrew, were applied under hypobaric conditions that prevail in an intact cockpit. With respect to alertness and performance, the results of this study showed no significant differences between loratadine and placebo during a period of 1 to 6 hours after drug ingestion. Triprolidine, used as a positive control, showed significant detrimental effects on both subjective and objective measures. It is anticipated that a single dose of loratadine 10 mg will not affect flying performance. This finding might also have implications for the treatment of allergic disorders of personnel involved in other highly skilled jobs.

Pentobarbital affects transepithelial electrophysiological parameters regulated by protein kinase C in rat distal colon.

For rat distal colon, the transepithelial electrical parameters, short circuit current (Iscc) and transepithelial electrical resistance (TER), respectively, measure net transepithelial electrolyte transport activity and the barrier function of the epithelium. Studies with a variety of epithelial cell cultures have shown greater than 90% decreases of TER within minutes of exposure of in vitro cell sheets to phorbol esters. The phorbol ester and protein kinase C (PKC) activator, phorbol dibutyrate (PDBU), was observed to produce an over 100% elevation of Iscc but only a small yet significant 20-30% decrease of TER across rat distal colon. Inhibition of the above effects of PDBU by the PKC inhibitor bisindolylmaleimide (GFX) is further evidence that in rat distal colon, Iscc and TER are under regulatory control by PKC. When animals received anesthesia with intraperitoneal pentobarbital prior to removal of the colon, the effect of PDBU on Iscc was significantly reduced, and the effect of PDBU on TER was almost completely inhibited. This effect of pentobarbital on PKC-mediated transepithelial permeability parameters is consistent with the known ability of anesthetics to alter protein kinase C activity. Exposure of rat colon to pentobarbital produced as much as a 90% inhibition of calcium-dependent PKC activity, whereas calcium-independent activity was stimulated by as much as 35%. Prior anesthetic use may be therefore a complicating factor in observing PKC-mediated effects on epithelial barrier function using epithelial tissue models.