[Severe pelvic injuries: indications and techniques of skeletal fixation]. / I traumi complessi del bacino: indicazioni e tecniche della stabilizzazione scheletrica.

The aim of this work is to assess the role of immediate Hoffmann's external fixation frame and delayed posterior internal fixation in the management of severe pelvic injuries. We have also analysed the role of selective arteriography and embolization for controlling pelvic fractures hemorrhage and the relationship between embolization and external fixation in the management of severe bleeding. We reviewed 112 patients with severe pelvic injuries admitted to our hospital from 1986 to 1998 (71 males, 41 females). The average age was 39.8 years, mean ISS 31.2. Unstable pelvic ring fracture was present in 59 (52.6%) patients at admission in the emergency room: hemorrhagic shock in 43 patients (38.3%). Fourteen (12.5%) patients died. Eight deaths (57%) were directly caused by hemorrhagic shock, two secondary to major caval lesion, three brain lesions and two respiratory failure. The last patient died secondary to MOF. Twenty-three patients (20.5%) with unstable fracture underwent pelvic fracture ring fixation surgery: eleven (9.8%) Hoffmann's anterior external fixation frame (hemorrhage control in all patients) and eight (7.1%) delayed internal posterior fixation. Six (5.3%) patients underwent arteriography and embolization: hemorrhage was stopped in all cases and no patient died in this group.

Cytogenetic monitoring of a village population potentially exposed to a low level of environmental pollutants. Phase 1:SCE analysis.

By analogy to the techniques applied for monitoring biological effects of exposure to genotoxic agents in occupational populations, we have carried out cytogenetic monitoring in a group of inhabitants of a village (Mellery, Belgium) suspected to have been exposed to a variety of toxic environmental pollutants. These pollutants probably originated from a neighboring chemical wastes site. A group of 51 environmentally exposed and 52 reference persons (including children) were examined for the frequency of sister-chromatid exchanges (SCE) in their peripheral blood lymphocytes. The technique was further refined by using a high frequency cells (HFC) analysis. Analysis of the reference subgroups showed a significant difference between non-smoking adults and children. The influence of tobacco was clear, too. In the exposed group, no significant differences could be demonstrated between either the smokers or the non-smokers or the children. Furthermore, not only were the mean frequencies of SCE higher than in the respective reference subgroups but comparison between the two groups also showed a higher number of individuals presenting a HFC level above the background in the exposed group. Surprisingly, the difference was more pronounced for the children. A follow-up of the same exposed population carried out 18 months later and after remediation of the atmospheric chemical release, the previously observed tendencies in the exposure parameter remained unmodified.

Increased sister chromatid exchange frequencies observed in a cohort of inhabitants of a village located at the boundary of an industrial dumping ground: phase I.

Since the mid-eighties, a sand pit located at the boundary of Mellery, a small village in Belgium, has been used as a dumping ground for industrial waste. After a particularly dry summer, many people complained of very foul smells coming from the dumping ground. An analysis of the environmental atmosphere detected alkanes and chlorinated saturated and unsaturated hydrocarbons in various concentrations. Consequently, the Belgian Ministry of the Environment requested additional measurements from the dumping site and the surrounding regions. Given the hazards and possible ill health effects associated with simultaneous exposure to low levels of many chemicals, biomarkers of personal exposure were measured in a representative group of people living in this village. The cytogenetic consequences of daily exposure to a mixture of genotoxicants were measured by the Sister Chromatid Exchange assay. The study included a group of 51 environmentally exposed persons (including 11 children) and 52 controls. A significant increase in Sister Chromatid Exchange frequency was detected among the inhabitants of the village compared to that of the control group, especially among the children living in Mellery as compared to the matched control children.