Measurement of radioxenon and radioargon in soil gas collected in the region of Kvarntorp, Sweden.

Over 40 soil gas samples were collected both in post-industrial areas as well as in undisturbed areas in the region of Kvarntorp, Sweden. Radioxenon (133Xe) was detected in 15 samples and radioargon was detected in 7 from 10 samples analysed. The concentration of radioxenon and radioargon in soil gas ranged up to 109 mBq/m3 and 19 mBq/m3, respectively. During sample collection other soil gases such as radon, CO2 and O2 were also measured and soil samples were taken along with dose rate measurements. The field experiment presented here shows that it is possible to detect naturally occurring radioxenon and radioargon in soil gas simultaneously.

Association between serum interleukin-17A and clinical response to tofacitinib and etanercept in moderate to severe psoriasis.

BACKGROUND: Psoriasis is a systemic inflammatory disease with a pathophysiology involving interleukin (IL)-17. Tofacitinib is an oral Janus kinase inhibitor. Etanercept is a tumour necrosis factor-α inhibitor used in the treatment of psoriasis. Neither agent inhibits IL-17 directly. AIM: To evaluate correlations between circulating IL-17A and clinical efficacy in patients with psoriasis treated with tofacitinib or etanercept. METHODS: Serum concentrations of IL-17A homodimer and IL-17A/F heterodimer were determined by immunoassays at weeks 0, 4 and 12 in patients with moderate to severe psoriasis treated with placebo (n = 60), tofacitinib 5 mg twice daily (n = 184), tofacitinib 10 mg twice daily (n = 190), or etanercept 50 mg subcutaneously twice weekly (n = 190). Disease severity was assessed using the Psoriasis Area and Severity Index (PASI) and clinical response was defined as patients achieving ≥ 75% improvement from baseline PASI (PASI75). RESULTS: Serum levels of IL-17A homodimer at week 0 showed moderate correlation with PASI, with a Spearman correlation coefficient of 0.43. Furthermore, serum levels of IL-17A homodimer showed a clear correlation with clinical response, with a decrease of 57.1% in patients achieving PASI75 at week 12, but only 15.9% decrease in nonresponders. PASI75 responders had lower median concentrations of IL-17A (range across treatments: 0.24-0.27 pg/mL) at week 12 vs. nonresponders (0.37-0.62 pg/mL), regardless of the treatment. Serum IL-17A/F heterodimer showed similar decreases at week 12 in responders and nonresponders. CONCLUSIONS: Baseline serum IL-17A correlates moderately with psoriasis severity. Reduction in circulating IL-17A is required for disease remission regardless of therapeutic agent.

Screening trauma patients for alcoholism according to NIAAA guidelines with alcohol use disorders identification test questions.

Drinking pattern criteria (drinking frequency and number of drinks per occasion) issued by the National Institute on Alcohol and Abuse and Alcoholism (NIAAA) to screen primary practice patients for alcohol problems were evaluated in 1216 injured patients treated in a regional trauma center. Vehicular crash victims predominated (50.2%, of whom 64.5% were drivers), followed by victims of violence (31.2%) and nonviolent-injury victims (18.5%). Alcohol Use Disorders Identification Test (AUDIT) questions #1 (drinking frequency) and #2 (drinks/day) were used to assess the patients for current alcohol dependence (CAD). AUDIT responses roughly approximating NIAAA guidelines (high threshold: drinks > or = 4 times/week, > or = 5 drinks/day) and those indicating less drinking (low threshold: drinks > or = 2-3 times/ week, > or = 3 drinks/day) were chosen. Comparisons were made relative to sensitivity and specificity of responses in detecting CAD. When low threshold responses were used for either question, sensitivity to detect CAD increased overall (#1 from 0.53 to 0.80, #2 from 0.62 to 0.88) as well as among the subgroups of patients, whereas specificity remained high or at acceptable levels overall (#1 from 0.95 to 0.82, #2 from 0.92 to 0.71) and among the subgroups of patients. Study findings suggest that, among injured drivers and other groups of trauma center patients, lesser amounts of drinking should be used as screening criteria for CAD than are used for the general population.

Detection with MR imaging of residual tumor in the breast soon after surgery.

OBJECTIVE: Difficulties in the preoperative assessment of tumor size and extent result in a positive pathologic margin in up to 70% of patients undergoing breast conservation surgery. Although positive margins usually require reexcision, the location and extent of surgery required are often difficult to establish by current imaging techniques. We investigated the accuracy of three-dimensional rotating delivery of excitation off resonance (3D RODEO) MR imaging of the breast in revealing the presence and extent of residual tumor within the breast soon after surgery. MATERIALS AND METHODS: Nineteen patients who had undergone lumpectomy or excisional biopsy were evaluated with contrast-enhanced 3D RODEO MR imaging of the breast within 10 months after surgery. The MR imaging results were correlated with serial-sectioned mastectomy or partial mastectomy specimens from 18 patients and with a clinical and mammographic follow-up examination in one patient. RESULTS: We found that 3D RODEO MR imaging accurately revealed the presence or absence and the location and extent of recurrent tumor in 15 of the 18 patients who had pathologic confirmation. Of the three MR imaging-pathology mismatches, two had irregular or nodular enhancement that corresponded to microabscesses. The third mismatch showed multicentric disease on MR imaging but only single-quadrant lobular carcinoma at pathologic examination. Our 19th patient showed no evidence of recurrent tumor on MR imaging or at 2-year follow-up clinical and mammographic examinations. CONCLUSION: MR imaging with 3D RODEO technique correctly revealed the presence or absence, the location, and the extent of recurrent tumor in 84% of patients who had recently undergone breast surgery.

The accuracy of the CAGE, the Brief Michigan Alcoholism Screening Test, and the Alcohol Use Disorders Identification Test in screening trauma center patients for alcoholism.

OBJECTIVE: To evaluate the accuracy of questionnaire screening instruments to identify lifetime alcohol dependence among trauma center patients. METHODS: The study was conducted at a Level I trauma center between September 1994 and November 1996. Patients meeting eligibility requirements (> or = 18 years old, admission from injury scene, > or = 2 days of hospitalization, intact cognition) were evaluated for alcohol abuse and dependence. Screening instruments consisted of the CAGE, the Brief Michigan Alcoholism Screening Test, and the Alcohol Use Disorders Identification Test. Screening results were compared with lifetime alcohol dependence diagnoses made using the in-depth Psychoactive Substance Use Disorders section of the Structured Clinical Interview. Accuracy was quantified as sensitivity, specificity, positive/negative predictive values, and receiver operating characteristic curves (used to calculate area under the curve). RESULTS: Of the 1,118 patients studied, lifetime alcohol dependence was diagnosed by Structured Clinical Interview in 397 (35.5%), and abuse was diagnosed in 90 (8.1%) others. The CAGE was the best predictor of lifetime alcohol dependence, i.e., had the largest area under the curve (93%) and the highest sensitivity (84%), specificity (90%), positive predictive value (82%), and negative predictive value (91%). Among patients testing positive for alcohol, 63% had a lifetime alcohol dependence diagnosis. CONCLUSION: The CAGE is an efficient screening test to detect alcohol dependence in trauma center populations. It should be used in combination with alcohol testing to identify patients at risk of alcohol use problems.

Three-dimensional RODEO breast MR imaging of lesions containing ductal carcinoma in situ.

PURPOSE: To assess whether rotating delivery of excitation off resonance (RODEO) breast magnetic resonance (MR) imaging can help detect ductal carcinoma in situ (DCIS) lesions, determine tumor extent, and differentiate pure DCIS from DCIS with an invasive component. MATERIALS AND METHODS: Twenty-two patients with DCIS lesions were evaluated with three-dimensional RODEO MR imaging. Nineteen patients had available mammograms for review. RESULTS: MR imaging enabled detection of all 22 cases of DCIS, DCIS with microinvasion, or invasive ductal carcinoma with extensive intraductal component. A clumped enhancement pattern was seen on MR images in all cases of pure DCIS. Spiculated enhancement was seen in four of six (67%) patients who had DCIS with microinvasion and in nine of 11 (82%) who had invasive ductal carcinoma with extensive intraductal component. RODEO MR imaging enabled accurate determination of tumor extent in 21 of 22 (95%) patients. Mammography depicted 18 of 19 DCIS lesions. No mammographic feature helped differentiate pure DCIS from DCIS with microinvasion. Mammography enabled accurate determination of tumor extent in 14 of 19 (74%) patients. CONCLUSION: Three-dimensional RODEO MR imaging can be an adjunct to mammography because of its ability to enable better determination of tumor extent and differentiation of pure DCIS from DCIS with an invasive component.

Experimental treatment of equine sarcoid using a xanthate compound and recombinant human tumour necrosis factor alpha.

A xanthate compound with antiviral and antitumoural activities, tricyclodecan-9-yl-xanthogenate (D609) in combination with the potassium salt of the lauric acid (KC12) and, in a further investigation, the above-mentioned substances together with recombinant human TNF alpha (rh-TNF alpha), were tested on equine sarcoid tumours for therapeutic efficacy. A pilot investigation on 5 healthy horses showed that the compounds were well-tolerated; apart from a local, temporary oedema at the injection site, no other clinical symptoms were observed after subcutaneous administration of volumes from 0.1 to 10 ml per injection. The tested concentrations of D609 and KC12 (5 mg/ml solution) and of rh-TNF alpha (50 micrograms/ml) were used for the treatment experiments. The repeated injections of the compounds to 11 sarcoid affected horses were also well-tolerated, except by one horse. In this case the treatment had to be interrupted after two injections because of severe reaction, i.e. fever and lameness due to oedemas. Five horses (n = 6 sarcoids) were treated by local, subcutaneous injection of D609 and KC12 under the tumour at intervals of 3 weeks. On one periocular sarcoid the compounds were applied as an ointment. After a follow-up period of 18 months, 5 tumours did completely regress and one remained unchanged. The periocular tumour showed a reduction in size. Five horses (n = 9 sarcoids) were then treated with a combination of D609, KC12 and rh-TNF alpha.(ABSTRACT TRUNCATED AT 250 WORDS)

Pre-existing disease in trauma patients: a predictor of fate independent of age and injury severity score.

Improvement in trauma management requires a better understanding of the effect of a patient's preinjury health status on outcome. Specific historical findings and laboratory criteria were used to define pre-existing disease (PED) states and determine if they were independent predictors of fate in trauma victims. Of 7,798 adult patients admitted to a level I trauma center from July 1986 through June 1990, 16.0% (1,246) had greater than or equal to 1 PED. The PED+ and PED- patients had no significant difference in Injury Severity Scores (ISSs) (15.7 versus 15.6) and admission Glasgow Coma Scale (GCS) scores (13.9 versus 13.8). The PED+ patients were older (49.2 versus 30.6 years) (p less than 0.001) and had a higher mortality rate (9.2% versus 3.2%) (p less than 0.001) than PED- patients. Mortality rates were also elevated for patients with greater than or equal to 2 PEDs (18%) and for those with renal disease (38%), malignancy (20%), and cardiac disease (18%) (p less than 0.001) compared with PED- patients. Controlling for age and ISS, there was an association between PED and mortality (Mantel-Haenszel p less than 0.03). Multivariate regression showed that PED is an independent predictor of mortality (R2 = 0.1918; p less than 0.0001). The greatest increases in mortality were found among patients less than 55 years and with ISS less than 20. Changes in prehospital triage criteria and outcome scoring are needed. Improvements in the management of trauma victims with chronic disease may decrease their mortality rate.

Septicaemia caused by unusual Campylobacter species (C. laridis and C. mucosalis).

Two cases of campylobacter septicaemia are described. The first, caused by Campylobacter laridis was associated with gastroenteritis and occurred in a healthy individual. In the second case, a catalase negative species, C. mucosalis was isolated from blood in an immunocompromised patient with symptoms of pneumonia. Both campylobacter strains grew faintly under the routine culture conditions used. Improved diagnostic procedures for Campylobacter species may thus be warranted.

Marijuana and alcohol use among 1023 trauma patients. A prospective study.

Marijuana use prior to injury was determined prospectively in 1023 patients injured as the result of vehicular (67.6%) and nonvehicular (32.4%) trauma. Most were men (72.8%); most were 30 years of age or younger (58.4%). All were admitted directly from the scene of injury. Serum delta-9-tetrahydrocannabinol activity was ascertained using a radioimmunoassay. Activity of 2 ng/mL or more was detected in 34.7% of subjects. Blood alcohol determinations were made in 1006 patients; 33.5% were positive. Marijuana use among vehicular and nonvehicular trauma victims was not significantly different. Marijuana use was higher among those 30 years of age or younger and among men. Vehicular crash victims consumed alcohol more frequently. Use of marijuana and alcohol in combination (16.5%) was highly significant compared with marijuana alone (18.3%), alcohol alone (16.1%), or neither drug (49.1%).

A national alcohol and trauma center survey. Missed opportunities, failures of responsibility.

The results of a national survey of trauma centers concerning their assessment and response to the problem of alcohol and trauma are reported. Surveys were returned from 154 trauma centers located in 43 states and the District of Columbia. The profile of the 125,000 patients treated at the centers is a 30-year-old man sustaining blunt trauma, usually in a vehicular crash. Two-thirds of centers estimated that the majority of their patients had abused alcohol. While acknowledging alcohol as a significant cause of trauma, only 55.2% of centers routinely obtain admitting blood alcohol levels. Less than a third of the centers employ alcoholism counselors. Most trauma centers are not providing services that allow them to fulfill their responsibility to detect and initiate treatment of alcohol abuse, a major cause of traumatic injury.

Stroke before 55 years of age at Karolinska Hospital 1973-77. A study of 399 well-defined cases. Risk indicators and etiological considerations.

The etiological characteristics of cerebrovascular disease (CVD) before the age of 55 are reviewed in 399 patients admitted to the Department of Neurology, Karolinska Hospital, Stockholm, from 1973-77. The material was well-defined with regard to subtypes of stroke as well as to the diseased population. The control material consists of 829 males and females of corresponding age randomly selected from the Stockholm population. In the ischemic group, 61% had angiographic evidence of atherosclerosis and, compared to controls, in most patient groups a significant (P less than 0.05-0.001) association with hypertension, diabetes, heart disease and smoking was found as well as for female patients under age 40 the use of oral contraceptives (P less than 0.001). In the hemorrhagic group, angiography demonstrated aneurysms in 76% of the patients with subarachnoidal bleeding but also atherosclerotic lesions in about 12% of the whole group. This would imply that atherosclerosis is an important precursor also for hemorrhagic lesions, further supported by a significant (P less than 0.01-0.001) association of hypertension, diabetes and smoking with this group.

PIP: This study investigated the etiologic characteristics of cerebrovascular disease (CVD) before the age of 55 years in 399 patients admitted to Karolinska Hospital, Stockholm, in 1973-77. 829 age-matched controls were randomly selected. Cases were further classified by subtype of CVD: subarachnoid, intracerebral, ischemic, and unclassified lesions. A family history of cerebrovascular incidents, heart disease, other vascular diseases, diabetes, and hypertension was reported in 10-30% of the cases. Among male cases with ischemic lesions before age 40, a history of treated diabetes, heart disease, and smoking was reported significantly more often than by controls. Among comparable female cases, a history of treated hypertension and oral contraceptive (OC) use at the onset of the disease was found significantly more often than in controls. In terms of ischemic lesions after the age of 40, a history of treated hypertension and smoking was significantly more frequent in male and female cases than in corresponding controls; treated diabetes and heart disease were reported more often in male cases only. No differences between cases and controls were found in the use of OCs. 61% of cases in the ischemic group had angiographic evidence of atherosclerosis. In the hemorrhagic group, angiography demonstrated aneyrysms in 76% of patients with subarachnoid bleeding but also atherosclerotic lesions in 12% of the whole group, implying that atherosclerosis is an important precursor for hemorrhagic lesions as well. The results from this study seem to support an association between OC use and circulatory complications; however, since mortality rates from circulatory disease are declining in countries where OC use is widespread, conclusions about a casual relationship may be unwarranted.

Gastric rupture from blunt trauma. A plea for minimal diagnostics and early surgery.

This paper reviews a series of gastric perforations resulting from blunt abdominal trauma. Over an 8-year period from January 1, 1974 to December 31, 1982, a total of 1412 patients were treated for significant intra-abdominal injuries. All injuries resulted from blunt abdominal trauma. Patients were transported by helicopter to our statewide trauma center. Fourteen patients sustained 47 perforating injuries to the gastrointestinal tract; six patients (0.4%) had gastric perforations and averaged 1.3 associated intraabdominal injuries. The gastric injuries included three greater curve lacerations: one anterior wall tear, 10 cm long, extended through the esophagogastric junction, and two lacerations involved the anterior wall of the distal antrum. Five of the six patients (83.3%) complained of severe abdominal pain on admission and had bloody returns from subsequent peritoneal lavages. The sixth patient had two negative lavages 7 hours apart but underwent laparotomy for persistent symptoms. Five patients had upright chest roentgenograms, and one patient demonstrated free subdiaphragmatic air. Patients with severe abdominal pain following blunt abdominal trauma require early celiotomy. Classic diagnostic findings, e.g., free intraperitoneal air, shock, and positive paracentesis, may be absent. The gastric injuries were repaired with a two-layer technique. Two patients (33%) developed intra-abdominal sepsis and required surgical drainage. One patient required pyloroplasty and vagotomy for stress-induced gastric bleeding. All six patients survived. The high mortality of gastric perforation can be mitigated by early diagnosis and surgical intervention.

Infected false femoral artery aneurysms secondary to monitoring catheters.

Six patients who developed infected false femoral artery aneurysms secondary to monitoring catheters are reported. All aneurysms were infected and resulted in systemic sepsis. Initially the origin of the sepsis was not obvious. Findings which suggest this lesion include staphylococci. Appearance of distal petechial hemorrhages should lend a strong suspicion to the possibility of the lesion. Appearance of the pulsatile groin mass completes the diagnosis. Only aneurysmal resection combined with appropriate antimicrobial therapy is curative. For necessary revascularization procedures, autogenous vein grafts should be used when available.

Superiority of the femoral artery of monitoring. A prospective study.

Continuous hemodynamic monitoring and ease of blood sampling are advantages of indwelling arterial catheters. The use and associated morbidity of arterial monitoring catheters were studied prospectively. Ninety-five percent of patients catheterized had multiple injuries, and almost 75 percent were 40 years of age or younger. Major and minor complication rates were similar with radial and femoral catheters, while the longevity of femoral catheters was almost twice that of radial catheters. Radial catheter-related sepsis did not occur when the duration of catheterization was less than 4 days. Tissue loss secondary to radical catheters can be minimized by immediate catheters can be minimized by immediate catheter removal upon appearance of ischemic changes. Our data support the preferential use of the femoral artery for long-term monitoring catheters in a younger patient population.

Management of severe bleeding in fractures of the pelvis.

The successful control of severe hemorrhage secondary to pelvic fracture can be a difficult problem. This is not surprising considering the extensive vascularity of the pelvic sink with its collateral circulation of major vascular loops. Appreciation of this complex anatomy should alert physicians to sources of severe hemorrhage and guide their therapeutic decisions. Although many techniques are available for reducing hemorrhage, no one technique has universally produced successful results. Whatever method is initially used, surveillance to recognize a therapeutic failure is necessary. If bleeding continues, other methods should be used. A planned systematic approach based on the availability of various modalites to achieve hemostasis is suggested.

Gallbladder injuries resulting from blunt abdominal trauma: an experience and review.

Over a seven-year period from 1973 through 1979, 31 patients with blunt gallbladder trauma were treated at the Maryland Institute for Emergency Medical Services Systems. Twenty patients had contusions, ten patients had avulsions and one patient had a perforation of the gallbladder. None of the gallbladder injuries were suspected preoperatively. Twenty-eight of the 31 patients had a diagnostic peritoneal lavage performed on admission, all were positive for blood; bile was not grossly evident. Among the 30 patients, there were 75 associated intraabdominal injuries; there were 25 liver injuries. Five patients died, none as a result of their gallbladder injury. Cholecystectomy is suggested as the definitive procedure of choice for severe contusions and for perforating and avulsive injuries to the gallbladder. Cholecystostomy is indicated in a few patients and should be regarded as a temporary procedure. A review of the English literature shows a total of 101 patients (including the 31 of this study) with gallbladder injuries secondary to blunt trauma. The most commonly reported injury was perforation. The 20 contusions described in the present study are the first such injuries reported.

Pitfalls of peritoneal lavage in blunt abdominal trauma.

Peritoneal lavage is a sensitive detector of intra-abdominal injury following blunt trauma. The open method of diagnostic lavage is advocated, because it is associated with less morbidity. Although quantitative and qualitative methods are available to interpret lavage returns, the results, in some patients, do not correlate with the severity of injury found at laparotomy. Diaphragmatic and extraperitoneal injury are illusive to detection by peritoneal lavage. Despite the pitfalls of peritoneal lavage, we still recommend its use for all patients suspected of having an intra-abdominal injury.