Mechanisms and patterns of injuries related to large animals.

BACKGROUND: Injuries from encounters with large animals represent a significant health risk for rural communities. We evaluated our regional trauma centers' experience with large-animal injuries to determine whether certain mechanisms and patterns of injury predicted either major head/craniofacial or torso (chest/abdomen/pelvis) trauma. METHODS: The hospital courses of 145 patients with injuries related to large animals were reviewed retrospectively to determine patterns of injury, specific injury mechanisms, species-specific injuries, and predictors of multiple body region trauma. RESULTS: Seventy-nine patients (55%) were injured by horses, 47 patients (32%) by bulls, 16 patients (11%) by cows, and 3 patients (2%) by wild animal attacks. The predominant species-specific mechanisms of injury were falls (horses), tramplings (bulls), and kicks (cows). Brain/craniofacial injuries were most common from horse-related encounters (32%), whereas bull and cow encounters usually resulted in torso injuries (45% and 56%, respectively). Multiple body region injuries occurred in 32% of patients. Fractures of the upper extremities were more often associated with torso and head/craniofacial injuries (48%) than lower extremity injuries (17%) (p = 0.02). CONCLUSION: Large animal injuries frequently involve multiple body regions with species-specific mechanisms. Upper extremity injuries are associated with a significantly higher percentage of torso and head/craniofacial injuries, which may have implications for field triage.

Early detection and monitoring of cancer with the anti-malignin antibody test.

The serum anti-malignin antibody (AMA) test determines the antibody to malignin, a 10,000-Da peptide present in patients with a wide variety of cancers. A total of 3315 double-blind tests demonstrated that AMA is a general transformation antibody, elevated in active nonterminal cancer, regardless of the site or tissue type, with sensitivity and specificity of 95% on the first determination and > 99% on repeat determinations. Data have not however been published yet that indicate whether, in daily clinical practice, the AMA test provides accurate prospective and predictive information. Forty-two physicians from 11 states, who ordered the AMA test, performed blind, report here on their results on 208 determinations in the first consecutive 181 patients and controls. Used in monitoring treatment in 56 patients, the test predicted or agreed 94.1% overall with the clinical status. Used in early detection in 125 patients and controls, of which 118 now have confirmed diagnoses, AMA was elevated in 21, all of whom were proven to have cancer; AMA was normal in 97, none of whom had cancer. Transient elevated AMA occurred in 3%, followed by normal values. Seven patients with still uncertain diagnosis who have had elevated AMA on repeated tests for 1 year or longer include six who are symptomatic, and three whose families have a high frequency of cancer. The conditions of these 7 may include undetected cancer because of the 118 with now certain diagnosis the AMA test predicted all correctly. From our experience, the AMA test should be used together with other routine procedures whenever signs and symptoms suggest cancer to facilitate early detection.

Popliteal artery injury with fractural dislocation of the knee.

If the reviewer has learned anything from this collected series of patients, it is that aggressive management is necessary. Preoperative and especially postoperative arteriography is essential for a high limb salvage rate. The vascular repair should receive priority, and early aggressive fasciotomy may be necessary. If orthopedic repair is done first, it should be done expeditiously so as to not prolong ischemic time. External fixation is recommended in the management of associated orthopedic injury.