Reversible Diels-Alder and Michael Addition Reactions Enable the Facile Postsynthetic Modification of Metal-Organic Frameworks.

Functionalization of metal-organic frameworks (MOFs) is critical in exploring their structural and chemical diversity for numerous potential applications. Herein, we report multiple approaches for the tandem postsynthetic modification (PSM) of various MOFs derived from Zr(IV), Al(III), and Zn(II). Our current work is based on our efforts to develop a wide range of MOF platforms with a dynamic functional nature that can be chemically switched via thermally triggered reversible Diels-Alder (DA) and hetero-Diels-Alder (HDA) ligations. Furan-tagged MOFs (furan-UiO-66-Zr) were conjugated with maleimide groups bearing dienophiles to prepare MOFs with a chemically switchable nature. As HDA pairs, phosphoryl dithioester-based moieties and cyclopentadiene (Cp)-grafted MOF (Cp-MIL-53-Al) were utilized to demonstrate the cleavage and rebonding of the linkages as a function of temperature. In addition to these strategies, the Michael addition reaction was also applied for the tandem PSM of IRMOF-3-Zn. Maleimide groups were postsynthetically introduced in the MOF lattice, which were further ligated with cysteine-based biomolecules via the thiol-maleimide Michael addition reaction. On the basis of the versatility of the herein presented chemistry, we expect that these approaches will help in designing a variety of sophisticated functional MOF materials addressing diverse applications.

Distribution and source apportionment studies of heavy metals in soil of cotton/wheat fields.

Heavy metals enriched agricultural soils have been the subject of great concern because these metals have potential to be transferred to the soil solution and afterward accumulated in food chain. To study the trace metal persistence in crop soil, 90 representative soil samples were collected and analyzed for heavy metal (As, Cd, Cu, Fe, Mn, Ni, Pb, and Zn) and anions (chloride, nitrates, phosphates and sulfates). Cluster and factor analysis techniques were used for the source identification of these excessive heavy metal levels and ecological risk was determined with potential ecological risk assessment. The degree of enrichment of eight studied heavy metals in comparison with the corresponding background levels decreased in order: Cd > Pb > Fe > Ni > Mn > As > Cu ~ Zn. Arsenic and cadmium exhibited 1.30- and 1.64-fold exceeded levels than threshold limits set by National environment quality standards, respectively. Cd in cotton field's soil may lead to higher potential risk than other heavy metals. On overall basis, the cumulative mean potential ecological risk for the district (207.75) corresponded to moderate risk level with higher contributions from As and Pb especially from Cd. Cadmium formed strong positive correlation with phosphate content of soil at p < 0.01. Cluster analysis indicated that Cluster 1 (extremely polluted) probably originated from anthropogenic inputs of phosphate fertilizer and past usage of arsenical pesticides.

Monitoring and distribution patterns of pesticide residues in soil from cotton/wheat fields of Pakistan.

The excessive use of hazardous pesticides for massive cotton and wheat production has deteriorated the quality of Okara district's soil. Thus, in order to sustain the production of good-quality food, it is essential to determine the residue levels of pesticides in the agricultural soil and define their possible sources. Thus, the present study focused on the determination of selected pesticides in the soil samples obtained from cotton/wheat fields by using the modified multi-residue pesticide analysis method based on GCMS and HPLC-UV. Most of soil samples were found to be highly contaminated with imidacloprid, chlorpyrifos, and α-cypermethrin residues. Selected pesticides were significantly correlated with each other at p < 0.05 except imidacloprid, which was negatively correlated with triazophos, MCPA methyl ester, selected pyrethroid pesticides, and their metabolite. Soil pH and phosphate levels were significantly positively correlated while sulfate content was negatively correlated with most of selected pesticides. The varimax normalized factor analysis divides the selected pesticides to the two major factors that explained 87.19% of the total variance which evidenced that pesticide in the same cluster shared a common source in the soil. A significant negative correlation of chlorpyrifos in the second factor pointed towards a source different from other pesticides. Factor and cluster analysis indicated that sulfate levels of soil positively affected the persistence/ mobility of imidacloprid.

Orbital mass secondary to acute lymphoblastic leukaemia in a child: a rare presentation.

We report the case of a 3-year-old child, who presented with lid swelling which progressed to proptosis of the left eye. He also had systemic symptoms of fatigue and weight loss. An examination revealed hepatosplenomegaly and lymph node enlargement. Investigations showed a peripheral smear with blast cells, which were also revealed through a bone marrow biopsy. A CT scan showed a mass lesion in the left orbit that had infiltrated into the surrounding tissues. He was diagnosed with acute lymphoblastic leukaemia (ALL) with left-sided orbital mass secondary to it. Haematogenous masses in the orbit are commonly due to granulocytic sarcomas, which are usually associated with acute myelogenous leukaemia (AML), not ALL, and are rare especially when they precede systemic disease.

A phase II randomized placebo-controlled trial of omega-3 fatty acids for the treatment of acute lung injury.

OBJECTIVES: Administration of eicosapentaenoic acid and docosahexanoic acid, omega-3 fatty acids in fish oil, has been associated with improved patient outcomes in acute lung injury when studied in a commercial enteral formula. However, fish oil has not been tested independently in acute lung injury. We therefore sought to determine whether enteral fish oil alone would reduce pulmonary and systemic inflammation in patients with acute lung injury. DESIGN: Phase II randomized controlled trial. SETTING: Five North American medical centers. PATIENTS: Mechanically ventilated patients with acute lung injury ≥18 yrs of age. INTERVENTIONS: Subjects were randomized to receive enteral fish oil (9.75 g eicosapentaenoic acid and 6.75 g docosahexanoic acid daily) or saline placebo for up to 14 days. MEASUREMENTS AND MAIN RESULTS: Bronchoalveolar lavage fluid and blood were collected at baseline (day 0), day 4 ± 1, and day 8 ± 1. The primary end point was bronchoalveolar lavage fluid interleukin-8 levels. Forty-one participants received fish oil and 49 received placebo. Enteral fish oil administration was associated with increased serum eicosapentaenoic acid concentration (p < .0001). However, there was no significant difference in the change in bronchoalveolar lavage fluid interleukin-8 from baseline to day 4 (p = .37) or day 8 (p = .55) between treatment arms. There were no appreciable improvements in other bronchoalveolar lavage fluid or plasma biomarkers in the fish oil group compared with the control group. Similarly, organ failure score, ventilator-free days, intensive care unit-free days, and 60-day mortality did not differ between the groups. CONCLUSIONS: Fish oil did not reduce biomarkers of pulmonary or systemic inflammation in patients with acute lung injury, and the results do not support the conduct of a larger clinical trial in this population with this agent. This experimental approach is feasible for proof-of-concept studies evaluating new treatments for acute lung injury.

Distribution, correlation, and source apportionment of selected metals in tannery effluents, related soils, and groundwater--a case study from Multan, Pakistan.

In order to study the distribution, correlation, and apportionment of selected metals, the tannery effluent, related soil, and groundwater samples were collected from Multan, Pakistan, and analyzed on flame atomic absorption spectrophotometer. Among the selected metals, Na, Ca, K, Cr, and Mg revealed dominant concentrations with average values of 5,499, 945, 565, 209, and 107 mg/L and 2,634, 330, 484, 14.1, and 60.5 mg/L in the effluents and groundwater, respectively, whereas the mean metal levels in soil samples were 10,026, 6,726, 9,242, 476, and 9,857 mg/kg. Overall, the mean metal concentrations in the tannery effluents, groundwater, and related soils reveal following order, respectively: Na > Ca > K > Cr > Mg > Ni > Fe > Zn > Co > Pb > Mn > Cd; Na > K > Ca > Mg > Cr > Zn > Ni > Pb > Fe > Co > Mn > Cd; Na > Mg > K > Ca > Cr > Co > Ni > Fe > Pb > Mn > Zn > Cd. Generally, the metal distribution in tannery effluents, soils, and groundwater was found to be random as evidenced by large differences between mean and median values as well as considerably higher standard deviation and skewness values. The selected metal data were also subjected to correlation study to investigate the covariation of metal levels in the three media. The source apportionment of the metal data in the effluents, soils, and groundwater was carried out using principal component analysis in addition to basic statistical and correlation analyses. The source apportionment studies evidenced the gross contamination of groundwater and soils in the vicinity of tanning industrial units in Multan. The current mean metal levels in the soil and groundwater were found to be considerably higher compared with the background concentration levels and WHO guideline values.

Zn2+ and Cd2+ assisted photo-catalytic degradation of chlorpyrifos in soil.

The Cd2+ and Zn2+ assisted photo-catalytic degradation of soil incorporated chlorpyrifos (CLP) was reported in current study. The soil samples fortified with CLP and metals were irradiated in photo-reactor for different time intervals to check maximum degradation. Soil samples extracted with acetonitrile were analyzed by HPLC. The results of the study revealed a complete mineralization of insecticide from soil that followed first-order Langmuir-Hinshelwood (L-H) kinetic model. The CLP degradation rate in soil was higher in photoreactor than control with variation in half-life from 41 days to 20 days. The degradation of CLP in photoreactor was 5 fold augmented after Zn2+ fortification of soil while Cd2+ had negligible effect on CLP photodegradation. Thus Zn2+ fortification of soil will not only replenish the important nutrient for plant growth but will also help in alleviating the harmful effects of CLP on soil flora and fauna by enhancing its rate of photodegradation.

Prospective evaluation of multidetector-row CT angiography for the diagnosis of vasospasm following subarachnoid hemorrhage: a comparison with digital subtraction angiography.

PURPOSE: To evaluate the accuracy of multidetector-row CT angiography (CTA) for the diagnosis of large-vessel vasospasm following subarachnoid hemorrhage by comparison to digital subtraction angiography (DSA). METHODS: Thirty-three patients with acute subarachnoid hemorrhage were enrolled in a prospective study and underwent a total of 40 CTA and DSA examinations within 24 h of each other. Two neuroradiologists reviewed the CTA examinations independently. A third neuroradiologist blinded to the CTA results reviewed the DSA examinations. In each patient, for both techniques, 23 arterial segments were evaluated for their degree of narrowing; the reviewers were asked to attribute every narrowing to 'vasospasm' or 'hypoplasia'. Agreement between CTA and DSA for the degree of narrowing, and agreement between the two CTA readers, were calculated using weighted kappa-coefficients. Sensitivity, specificity, accuracy, positive and negative predictive value (NPV) of CTA to detect large-vessel vasospasm were calculated considering DSA as the gold standard. RESULTS: Substantial correlation (kappa = 0.638) was found between CTA and DSA for the detection of arterial narrowing. Interobserver agreement between the two CTA reviewers for the degree of luminal narrowing was substantial (kappa = 0.712).CTA was 87% accurate for the diagnosis of large-vessel vasospasm; the NPV of CTA was 95%. CTA was more accurate, and interobserver agreement higher, for the proximal arterial segments (basilar and vertebral arteries) than for the distal ones (P2 segments). Using CTA as a screening modality, 83% of unnecessary DSA would have been avoided. CONCLUSION: Compared to the gold standard of DSA, CTA is accurate for the detection of large-vessel vasospasm, and has a very high NPV.

Multivariate analysis of the selected metals in the hair of cerebral palsy patients versus controls.

Seventeen metals were measured in scalp hair samples from cerebral palsy patients (CPPs) and controls. Samples were collected from 95 CPPs and 93 controls. The nitric acid-perchloric acid wet digestion procedure was used for quantification of the selected metals by flame atomic absorption spectrophotometry. The concentrations of Ag, Ca, Cd, Co, Cr, Li, and Mg were significantly higher and those of Cu, Fe, K, Mn, Na, Ni, Pb, and Sb were lower in the hair of CPPs compared with controls. Astrong positive correlation was found between Ca and Mg in the hair of controls but not in that of CPPs. Antimony was found significantly negative in terms of its correlation with Co and Cu in CPPs group but not in the controls. Principal component analysis (PCA) of the data extracted seven factors for CPPs and six factors for controls. Cluster analysis (CA) was also used to support the PCA results. The study evidenced some specific source of Mg and Sb in the hair of CPPs.

Cu(2+) and Fe(2+) mediated photodegradation studies of soil-incorporated chlorpyrifos.

The influences of Cu(2+) and Fe(2+) on the photodegradation of soil-incorporated chlorpyrifos were investigated in the present study. The soil samples spiked with chlorpyrifos and selected metal ions were irradiated with UV light for different intervals of time and analyzed by HPLC. The unsterile and sterile control soil samples amended with pesticides and selected metals were incubated in the dark at 25 °C for the same time intervals. The results of the study evidenced that photodegradation of chlorpyrifos followed the first-order kinetics. The dissipation t0.5 of chlorpyrifos was found to decrease from 41 to 20 days under UV irradiation. The rate of chlorpyrifos photodegradation was increased in the presence of both metals, i.e., Cu(2+) and Fe(2+). Thus, initially observed t0.5 of 19.8 days was decreased to 4.39 days in the case of Cu(+2) and 19.25 days for Fe(+2). Copper was found to increase the rate of photodegradation by 4.5 orders of magnitude while the microbial degradation of chlorpyrifos was increased only twofold. The microbial degradation of chlorpyrifos was only negligibly affected by Fe(2+) amendment. The studied trace metals also affected the abiotic degradation of the pesticide in the order Cu(2+) > Fe(2+).

Multivariate analysis of selected metals in tannery effluents and related soil.

Effluent and relevant soil samples from 38 tanning units housed in Kasur, Pakistan, were obtained for metal analysis by flame atomic absorption spectrophotometric method. The levels of 12 metals, Na, Ca, K, Mg, Fe, Mn, Cr, Co, Cd, Ni, Pb and Zn were determined in the two media. The data were evaluated towards metal distribution and metal-to-metal correlations. The study evidenced enhanced levels of Cr (391, 16.7 mg/L) and Na (25,519, 9369 mg/L) in tannery effluents and relevant soil samples, respectively. The effluent versus soil trace metal content relationship confirmed that the effluent Cr was strongly correlated with soil Cr. For metal source identification the techniques of principal component analysis, and cluster analysis were applied. The principal component analysis yielded two factors for effluents: factor 1 (49.6% variance) showed significant loading for Ca, Fe, Mn, Cr, Cd, Ni, Pb and Zn, referring to a tanning related source for these metals, and factor 2 (12.6% variance) with higher loadings of Na, K, Mg and Co, was associated with the processes during the skin/hide treatment. Similarly, two factors with a cumulative variance of 34.8% were obtained for soil samples: factor 1 manifested the contribution from Mg, Mn, Co, Cd, Ni and Pb, which though soil-based is basically effluent-derived, while factor 2 was found associated with Na, K, Ca, Cr and Zn which referred to a tannery-based source. The dendograms obtained from cluster analysis, also support the observed results. The study exhibits a gross pollution of soils with Cr at levels far exceeding the stipulated safe limit laid down for tannery effluents.

Photodegradation of α-cypermethrin in soil in the presence of trace metals (Cu2+, Cd2+, Fe2+ and Zn2+).

The influence of trace metals (Cu(2+), Zn(2+), Cd(2+) and Fe(2+)) on the photodegradation of α-cypermethrin (α-CYM) in agricultural soil was studied. The soil samples were spiked with α-cypermethrin with/without the presence of metal ions, irradiated under a UV irradiation chamber for a regular period of time and analyzed by using HPLC. The dark control sterile and unsterile soil samples spiked with α-cypermethrin and selected trace metals were incubated for the same interval of time at 25 °C. The results obtained indicated that α-cypermethrin photodegradation followed biphasic kinetics. α-cypermethrin photodegradation half-lives (t1/2) were increased to 0.71 and. 4.5 hours from 0.64 hours respectively in the presence of elevated Zn(2+) and Cu(2+) concentrations. Fe(2+) and Cd(2+) increased the photodegradation reaction kinetics from -1.078 h(-1) to -1.175 h(-1) and -1.397 h(-1) and varied the t1/2 from 0.64 ± 1.41 to 0.59 ± 2.07 and 0.49 ± 2.01 in the soil. Microbes also affected the degradation of α-cypermethrin in metal contaminated soil. The degradation rate was inhibited in unsterile soil and was found to be in the following order: Cd(2+)< Zn(2+)< Cu(2+)< Fe(2+). The degradation/persistence of α-cypermethrin was affected linearly with the increasing soil metal concentrations.

Practice variation in respiratory therapy documentation during mechanical ventilation.

STUDY OBJECTIVES: Implementation of new ventilatory strategies such as lung-protective ventilation for ARDS will require a multidisciplinary approach with considerable physician and respiratory therapy (RT) interaction. One of the key factors in this communication is complete and accurate RT documentation of ventilator settings. Few studies have explored the quality and variability of this documentation. DESIGN: Population-based cross-sectional study. SETTING: Seventeen adult hospitals in King County, WA. PARTICIPANTS/INTERVENTIONS: We compared the blank RT ICU flow sheet for each institution to the 1992 American Association for Respiratory Care (AARC) clinical practice guidelines (CPGs) for patient-ventilator system checks. We interviewed RT managers at each hospital about their practices. Finally, we reviewed selected charts of patients with acute lung injury (ALI) or ARDS from each hospital to evaluate the documentation. MEASUREMENTS/RESULTS: We found substantial variability in RT documentation practices and in their extent of compliance with the AARC CPGs. Only 15 of 52 items recommended by the AARC CPGs were included on blank RT flow sheets of every hospital in our study, and only 26 of 52 items were found on charts of ALI/ARDS patients at most hospitals (ie, > or =10 of 17 hospitals). Only 10 of 17 RT department managers reported using the AARC CPGs as a basis for their documentation policies. Items necessary for the implementation of lung-protective ventilation for ALI/ARDS patients were recorded inconsistently and were not included in the AARC CPGs. Plateau pressure was found on all reviewed charts of ALI/ARDS patients at only 10 of 17 hospitals. CONCLUSIONS: Considerable variability exists in RT documentation practices. We suggest that new guidelines be developed for documenting the care of patients receiving mechanical ventilation, in light of recent data on ventilator weaning and the management of ALI/ARDS, and that their effect on practice and outcomes be evaluated.

Early closure of colostomies in trauma patients--a prospective randomized trial.

BACKGROUND: Most traumatic colon injuries can be repaired primarily, but a colostomy may still be required for severe colonic or rectal injury. The current trend is to reverse the colostomy early, rather than to wait the traditional 3 months before closure. METHODS: Forty-nine patients with colostomies after abdominal trauma were entered into the study. All patients had undergone a contrast enema in the second postoperative week to assess distal colon healing. Patients were excluded from early closure for nonhealing of the bowel injury, unresolving wound sepsis, or an unstable condition. We then compared the outcome of the remaining 38 (77.6%) patients allocated to either an early or a late colostomy group in a controlled, prospective, randomized trial. RESULTS: We found no significant difference in morbidity between the two groups, with an overall complication rate of 26.3%. Technically the early closure of colostomies was far easier than late closure and required significantly less operating time (p = 0.036) and with less intraoperative blood loss (p = 0.020). The closure of end colostomies was more time consuming, both early (p < 0.001) and late (p < 0.001) and caused more bleeding (p < 0.001 and p < 0.001, respectively). Total hospitalization was marginally shorter overall for early closure, but late closure of end colostomies resulted in prolonged hospitalization (p = 0.023). CONCLUSIONS: The early closure of colostomies and the use of loop colostomies whenever possible are recommended as both safe and beneficial for patients with colonic injury after trauma. Contraindications for early closure include nonhealing distal bowel, persistent wound sepsis, or persistent postoperative instability.

Penetrating trauma to the heart: a relatively innocent injury.

BACKGROUND: The purpose of this study was to examine the mortality rate of penetrating cardiac trauma in a large urban hospital. METHODS: This was a retrospective study over a period of 5 years and 5 months of all patients admitted alive with a stab or a gunshot cardiac injury. RESULTS: There were 310 patients with a stab wound and 63 with a gunshot wound. The overall mortality rate was 19%. The mortality rates for the stab and the gunshot groups were 13% and 50.7%, respectively. In the 296 patients with a cardiac stab wound confined to a single chamber and with no other associated extracardiac injury the mortality rate was 8.5%. CONCLUSIONS: An isolated cardiac stab wound is a relatively innocent injury in a patient at a hospital accustomed to managing penetrating trauma expeditiously.

Selective surgical management of zone II gunshot injuries of the neck: a prospective study.

BACKGROUND: The management of penetrating neck trauma remains controversial, with many studies supporting either mandatory exploration or selective conservatism. METHODS AND RESULTS: This is a prospective study of 75 patients with gunshot injuries to zone II of the neck. Forty patients (53.3%) underwent immediate exploration because of clinical indications or positive initial investigations. A 7.5% incidence of unnecessary explorations, a 5% mortality rate, and average hospital stay of 10.5 days were noted. Thirty-five patients with negative clinical or investigational findings underwent observation with constant monitoring. A 5.7% incidence of missed injuries, no mortality, and an average hospital stay of 3.5 days were noted for these patients. CONCLUSIONS: We suggest that conservative management in gunshot injuries confined to zone II of the neck selectively supplemented by appropriate investigations is a viable proposition in this type of injury. Further contemporary studies reporting specifically on this injury will enable us to reach statistically significant conclusions.

Transmediastinal gunshot injuries.

BACKGROUND: Transmediastinal gunshot injuries are a rarely reported injury. Until recently, assessment of the thoracic aorta by angiography preceded the investigation of the esophagus. This order has been recently debated. METHODS: There were 118 patients with potential transmediastinal injuries included in this retrospective study. Unstable patients who were unresponsive to resuscitation were taken to the operating room without previous investigation. Stable patients were routinely investigated initially for injury of the aorta and then for injury of the esophagus. RESULTS: There were 51 patients who underwent urgent thoracotomy/sternotomy. In 27, the hemorrhage was of mediastinal origin; 17 of these patients died of intraoperative bleeding. Eight of the patients had aortic injury, and only one of this group survived. There were 57 stable patients who were investigated initially for injury of the aorta by angiography. It was positive in only one patient who underwent an operation with good results. An investigation of the esophagus followed and revealed esophageal injury in 17 patients. All of them were treated operatively, 15 of them with satisfactory outcome. CONCLUSIONS: Angiography should at present precede esophageal investigations. There is a need for shortening the time between admission and operation. Other modalities that could expedite the investigation of the thoracic aorta and the esophagus should be prospectively evaluated in multi-center studies.

Gunshot injuries of the liver: the Baragwanath experience.

BACKGROUND: This study comprised 304 patients with gunshot injuries of the liver, many of which from high-velocity firearms. The purpose of this study is to evaluate our management policy in gunshot injuries of the liver in light of our recent wider experience. METHODS: All grade I and II injuries and most grade III injuries were managed by simple operative measures, without postoperative mortality directly related to the liver trauma. RESULTS: Grade III, IV, and V injuries had 8.5%, 52%, and 16% resectional debridement rates and 8.5%, 38%, and 84% perihepatic packing rates, respectively. In the resectional debridement group the postoperative mortality rate was 15% (half the deaths were directly caused by the hepatic injury). The postoperative mortality rate in the perihepatic packing group was 31.5% of which 45% of deaths were due to ongoing bleeding, 27.5% to sepsis, and 27.5% to associated trauma. The septic complications were less common when packs were removed early. CONCLUSIONS: We suggest that resectional debridement and perihepatic packing should be liberally applied in the most severe grade III, most grade IV, and grade V gunshot injuries of the liver and that perihepatic packing should be removed as early as the physiologic derangements are corrected. Our experience with grade VI injuries is very limited, and their management should be studied in larger series.

Penetrating injuries of the iliac arteries: a South African experience.

BACKGROUND: We did a retrospective study of 62 patients with penetrating injuries of the iliac arteries. METHODS: The cause of injury was gunshot wound in 85.5% and stabbing in 14.5%. The arterial repair was achieved by various means: lateral arteriorrhaphy, end-to-end anastomosis, and polytetrafluoroethylene interposition grafts. RESULTS: There was a 42% mortality rate from exsanguination or secondary coagulopathy directly related to the arterial injury. Persistent shock, resuscitative thoracotomy, free intraperitoneal hemorrhage, and the number of vascular injuries were directly related to mortality. CONCLUSIONS: A high index of suspicion, aggressive resuscitation, and prompt surgery are necessary to improve the chances of surviving this ominous injury.

Outcome of a strict policy on emergency department thoracotomies.

OBJECTIVE: To audit emergency department thoracotomies from January 1981 to May 1993. DESIGN: Retrospective analysis of case records. SETTING: A large (3000-bed) tertiary care academic hospital; the department of general surgery (including trauma) consists of 360 beds. PATIENTS: All patients who underwent a thoracotomy in the emergency department during the above period. INTERVENTION: An emergency department thoracotomy was performed on trauma patients with recordable vital signs and rapid deterioration and on patients with uncontrollable bleeding or profound hypotension not responsive to resuscitation. The procedure was performed either on the resuscitation trolley in the emergency department or in the adjacent operating room. MAIN OUTCOME MEASURES: Survival and subsequent neurological function after thoracotomy. RESULTS: There were 312 stab injuries, 358 gunshot injuries, and 176 blunt injuries. Survival occurred in 26 stab-wound cases (8.3%), in 16 gunshot cases (4.4%), and in one blunt injury case (0.6%). There was one patient with neurological impairment in each of the three injury groups. Those with penetrating chest injuries had the best survival rate (20%), and the survival rate for penetrating abdominal trauma was 6.8%. CONCLUSIONS: Emergency department thoracotomies have a definite role in the management of trauma patients. The best results are obtained in patients with penetrating chest injuries.