Thoracic vessel injury.

Thoracic trauma occurs in an estimated 25% of all trauma victims, with approximately 50% of trauma mortalities attributable to these injuries. Only 4% of thoracic traumas involve injuries to thoracic vessels, including the aorta, innominate veins and artery, left carotid artery, internal mammaries, and pulmonary hilar vessels. These vascular injuries can range from minor to major with advances in prehospital management increasing the number of patients surviving in the field and presenting to the hospital with life-threatening vascular injuries. Rapid assessment during the initial survey and interventions to maintain airway, breathing, and circulation of the patient can be life-saving. The patient's hemodynamic status will often dictate the extent of the initial workup or whether the patient requires emergent operation. Stable patients can undergo further assessment and detailed imaging, such as computed tomography and/or angiography. Treatment of thoracic vessel injuries may include advanced endovascular techniques, traditional open surgery, or non-operative management with observation. The following review systematically details the initial workup, evaluation and management techniques of thoracic vessel injuries.

Functional profiling in Streptococcus mutans: construction and examination of a genomic collection of gene deletion mutants.

A collection of tagged deletion mutant strains was created in Streptococcus mutans UA159 to facilitate investigation of the aciduric capability of this oral pathogen. Gene-specific barcoded deletions were attempted in 1432 open reading frames (representing 73% of the genome), and resulted in the isolation of 1112 strains (56% coverage) carrying deletions in distinct non-essential genes. As S. mutans virulence is predicated upon the ability of the organism to survive an acidic pH environment, form biofilms on tooth surfaces, and out-compete other oral microflora, we assayed individual mutant strains for the relative fitness of the deletion strain, compared with the parent strain, under acidic and oxidative stress conditions, as well as for their ability to form biofilms in glucose- or sucrose-containing medium. Our studies revealed a total of 51 deletion strains with defects in both aciduricity and biofilm formation. We have also identified 49 strains whose gene deletion confers sensitivity to oxidative damage and deficiencies in biofilm formation. We demonstrate the ability to examine competitive fitness of mutant organisms using the barcode tags incorporated into each deletion strain to examine the representation of a particular strain in a population. Co-cultures of deletion strains were grown either in vitro in a chemostat to steady-state values of pH 7 and pH 5 or in vivo in an animal model for oral infection. Taken together, these data represent a mechanism for assessing the virulence capacity of this pathogenic microorganism and a resource for identifying future targets for drug intervention to promote healthy oral microflora.

PALML, a novel paralemmin-related gene mapping on human chromosome 1p21.

We describe PALML, a novel gene encoding a 551 amino acid protein with similarity to paralemmin and the paralemmin-like amino terminal domain of AKAP2, a protein kinase A anchor protein. PALML mRNA is expressed in many tissues and is most abundant in cardiac and skeletal muscle, while absent from brain and blood. Exogenously expressed PALML fusion protein has a widespread cytoplasmic localization, and it is excluded from the nucleus. Human PALML maps on human chromosome 1p21 (between D1S2767 and D1S223). SSCP-HD analysis of exonic sequences in patients with VUR (familial non-syndromic vesicoureteral reflux syndrome) excluded mutations in the PALML gene from causing this disease. PALML, paralemmin and AKAP2 share the presence of a conserved coiled coil region that may mediate protein interactions with shared partners. Based on its resemblance to paralemmin and AKAP2, PALML is hypothesized to be involved in regulating intracellular signaling and membrane-cytoskeletal interactions.

Psychiatry and the criminal justice system: testing the myths.

Several states are changing legislation and treatment programs for mentally ill offenders without knowing how current laws and programs operate. To address this problem the authors linked data from police records, court reports, and clinical files for 2,735 psychiatric referrals from the criminal justice system of Alaska from 1977 through 1981. They found that only 0.2%-2.0% of all schizophrenic persons in the community were arrested for violent crimes each year, accounting for 1.1%-2.3% of all arrests for violent crimes; that psychiatrists agreed about competency and responsibility in 79% of the cases evaluated by more than one clinician; and that a successful insanity defense occurred in 0.1% or less of all criminal cases.

Agonadism in two sisters with XY gonosomal constitution, mental retardation, short stature, severely retarded bone age, and multiple extragenital malformations: a new autosomal recessive syndrome.

We report on 12- and 14-year old sisters with a 46, XY chromosome constitution, normal female external genitalia, and absence of gonadal tissue. Except for omphalocele, right renal agenesis and malrotation of the colon in the elder sister, the internal organs were normal. Both were mentally retarded, of short stature, and had extremely retarded bone age. In addition, they had an almost identical pattern of minor anomalies: peculiar face, hypodontia, short neck, inverted nipples, thoracolumbar scoliosis, "dysplastic" hips, partial clino-/syndactyly of toes. The occurrence of a basically similar set of malformations in two sisters and the first cousin consanguinity of the parents suggests autosomal recessive inheritance. The conserved region of the SRY gene ([high mobility group] HMG box) was sequenced in the elder sib and was normal. No consistent malformations are observed at present in agonadal patients. This supports the idea that several autosomal genes have the potential of influencing the sequence of events of sex determination.

Treatment of hyperprolactinemic amenorrhea with Metergoline.

The ergoline derivative, Metergoline, in a dosage of 4 to 24 mg/day, was administered for one to eight months to 42 patients with hyperprolactinemic amenorrhea. Mean serum prolactin (PRL) concentrations before treatment were 91.2 ng/mL in the patients with functional hyperprolactinemia (N = 29) and 256.9 ng/mL in the patients with pituitary tumor (N = 13). Within four weeks, Metergoline treatment reduced these PRL concentrations to 39.5 ng/mL and 82.9 ng/mL, respectively. In this study Metergoline treatment resulted in restoration of menstruation in a total of 37 patients; 28 patients ovulated, and eight became pregnant. It is considerably more effective in functional hyperprolactinemia than in hyperprolactinemia caused by adenoma.

Hemorrhage induced by intrauterine devices: control by local proteinase inhibition.

The intrauterine application of proteinase inhibitors, tranexaminc acid and the pancreatic trypsin inhibitor (Trasylol), reduces or eliminates menorrhagia and intermenstrual bleeding (spotting) produced by an intrauterine device (IUD). A decrease in pain and vaginal (cervical) discharge is also frequently observed. A single application is usually sufficient, more than three never being required. The effect lasts for an average of three cycles. In addition to the clinical use of these agents for the treatment of uterine hemorrhage, the slow release of proteinase inhibitors from an IUD may well be useful in minimizing its side effects without interfering with its contraceptive activity.

PIP: 2 fibrinolytic inhibitors were evaluated in IUD-wearing women complaining of menorrhagia and spotting to determine if direct application into the uterus could reduce such side effects of IUD wear. The agents used were the proteinase inhibitor transexamic acid (AMCA) and a naturally occurring pancreatic trypsin inhibitor Trasylol. Solutions of the antifibrinolytic agents (1 gm/ml AMCA and 19 gm/ml Trasylol) were injected into th eue rine cavity. 10 of the women acted as control. Both agents reduce the length of the menstrual period by about 50% with a significant reduction in pain and vaginal discharge. This effect was usually sustained over several menstrual cycles. Local administration is more advantageous than the oral approach because smaller dosage is required and side effects thus reduced. It is suggested that proteinase inhibitors be incorporated directly into IUDs.

Homicide and blackout in alaskan natives: a report and reproduction of five cases.

Alcoholic amnesia was reproduced clinically in 5 Alaskan Native men who had committed homicide during previous alcoholic blackouts but had no recollection of events.

[Contraception in female risk patients]. / Kontrazeption bei Risikopatientinnen.

PIP: A discussion of which risk factors have been established as significant in prescribing O.C.s (oral contraceptives) is presented. The estrogen component of O.C.s influences the vitamin K dependent coagulation factors II, VII, IX, and X and causes disturbances in hemodynamics, leading to such illnesses as thromboembolism and myocardial infarction. 5% of O.C. users develop hypertension in the first 5 years of use. Previous cardiovascular illness, hypertension, vascular disorders, and other conditions are considered contraindications to O.C. use. Women who smoke, get migrane headaches, or who are over 35 years of age more often develop cardiovascular illness during O.C. use. Obesity, diabetes and hyperlipidemia are among the various risk factors that are related to developing cardiovascular illness or hypertension during O.C. use. O.C. users also can develop gall bladder illnesses; cholcystitis and cholelithiasis are contraindications to O.C. use. Post-pill amenorrhea occurs in .8-1% of O.C. users. O.C. users should undergo gynecological and medical checkups every six months; special consideration should be given if any of the risk factors are present.^ieng

[Hormonal changes in aging from the viewpoint of the gynecologist]. / Hormonelle Alternsveränderungen aus der Sicht des Gynäkologen.

The major relevant age-related changes that take place in women are caused by estrogen deficiency of rapid onset. This deficiency results in such changes as vaginal and vulval atrophy, atrophic urethrocystitis, breast flabbiness, thinning of the skin and its appendages, and also the severe metabolic changes like osteoporosis and cardiovascular disorders. All of these changes, in concert or alone, are capable of impairing a woman's sex life. Numerous genital complaints can be eliminated by local treatment with estriol cream, estriol vaginal suppositories, or systemic estriol. For the successful treatment of pronounced menopausal symptoms and the prevention of osteoporosis and cardiovascular disorders, estrogens at medium, so-called replacement, doses, given in combination with progestagen, are applied sequentially.

[The overweight and underweight girl: from findings to prevention]. / Das übergewichtige und das untergewichtige Mädchen: Vom Befund zur Prävention.

Both preponderance as well as underweight normally starts in childhood and puberty and hurt the fate of young women mostly a life long. Weight and fat tissue as an energy storage regulates through the hormone Leptin appetite, food intake and therefore the energy reserves. With this hormone exist a common pathophysiological regulation unit, which causes in case of preponderance an increased, in case of underweight a decreased cyclus activity. Besides short term influences (like the development of the PCO-syndrome and/or fatigue fractures) the long-term consequences especially the accumulation of the visceral fat, the cardio-vascular diseases, metabolic syndrome, type-II-diabetes, mammary- and endometrial carcinoma play a special role. On the other hand chronic underweight very frequently leads through chronic estrogen defect to osteopenia, osteoporosis and therefore to cyclus disturbances, sterility and osteoporosis. A simple finding like weight, has thus an important predictive quality for later illnesses and their prevention.

Bacterial colonization of intrauterine devices (IUDs).

The bacterial colonizing of the intrauterine device (IUD) and its tail were studied in 152 IUDs obtained from 70 symptomless IUD wearers, 13 women with dysfunctional bleeding, 23 women with pelvic inflammatory disease, 31 women in whom the tail of an IUD was no longer visible and 17 women who were pregnant with an IUD in situ. The IUDs were either removed by the transcervical route or through a fundal incision in the uterus after hysterectomy. Most IUD were heavily contaminated by bacteria, especially Staphylococcus epidermidis, Enterococci and anaerobic Lactobacilli. The number of colonies was higher in women with dysfunctional bleeding and pelvic inflammatory disease than in others with a predominance of pathogenic bacteria, namely beta-hemolytic Streptococci, Staphylococcus aureus and Escherichia coli. Almost half of the IUDs without a tail protruding through the cervix were sterile. With pregnancy in the presence of an IUD, 71% of devices grew bacteria which were mainly anaerobic.

[Obesity--significance in adolescence and for reproduction]. / Adipositas--Bedeutung für Adoleszenz und Reproduktion.

According to the actual knowledge obesity is a serious, nutrition-dependent pathology with a high number of consequences. Endocrine sequence of obesity such as PCO-HAIR-syndrome (polycystic ovarian syndrome, hyperandrogenemia-insulin-resistance) with its cycle disorders and sterility are beginning already in adolescent and women of young reproductive age. With ageing more serious risks such as non-insulin dependent diabetes mellitus (NIDDM), arteriosclerosis followed by coronary disease, stroke and hypertension, metabolic syndrome and a higher prevalence of malignant diseases will appear. Based on these five risks obesity should be treated early when therapeutic strategies are more successful than in older ages. The definition of a diagnosis and the beginning of a weight reduction programme combined with intense motivating treatment as well as medical and psychotherapeutic guidance is an important preventive contribution.

[Death following fructose and sorbitol infusions]. / Todesfall nach Fructose- und Sorbitinfusionen.

Hereditary Fructose Intolerance (HFI) is a rare inherited metabolic disease. Because of the wide application of infusions containing fructose and sorbitol, patients suffering from this disease are at special risk. The disease is frequently not diagnosed until adulthood and the danger associated with this delay is insufficiently recognized. This report therefore included a case history in which this is highlighted.