Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

PURPOSE: To compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels. MATERIALS AND METHODS: Patients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population. RESULTS: Of the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation-a difference that could not be attributed to differences in age, grade of injury or residual splenic volume. CONCLUSION: IgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function.

Predicting pre-Columbian anthropogenic soils in Amazonia.

The extent and intensity of pre-Columbian impacts on lowland Amazonia have remained uncertain and controversial. Various indicators can be used to gauge the impact of pre-Columbian societies, but the formation of nutrient-enriched terra preta soils has been widely accepted as an indication of long-term settlement and site fidelity. Using known and newly discovered terra preta sites and maximum entropy algorithms (Maxent), we determined the influence of regional environmental conditions on the likelihood that terra pretas would have been formed at any given location in lowland Amazonia. Terra pretas were most frequently found in central and eastern Amazonia along the lower courses of the major Amazonian rivers. Terrain, hydrologic and soil characteristics were more important predictors of terra preta distributions than climatic conditions. Our modelling efforts indicated that terra pretas are likely to be found throughout ca 154 063 km(2) or 3.2% of the forest. We also predict that terra preta formation was limited in most of western Amazonia. Model results suggested that the distribution of terra preta was highly predictable based on environmental parameters. We provided targets for future archaeological surveys under the vast forest canopy and also highlighted how few of the long-term forest inventory sites in Amazonia are able to capture the effects of historical disturbance.

Vertebroplasty in the management of traumatic burst fractures: a case series.

This study aimed to assess the role of percutaneous vertebroplasty (VP) in the management of acute traumatic burst fractures. We describe three cases where percutaneous VP was carried out for traumatic non-osteoporotic burst vertebral fractures. For clinical symptoms and the effect of the VP procedure to be assessed, all patients completed a visual analogue scale and a mobility score before the procedure and at day 1 and 3 months post procedure. Improvements in both pain and mobility scores immediately post procedure were seen in all patients, and these results persisted at 3-month follow up. Percutaneous VP provided a successful, minimally invasive treatment of these patients' traumatic fractures while avoiding major surgical procedures and associated surgical morbidity and complications.

The Bispectral Index in children: comparing isoflurane and halothane.

BACKGROUND: The Bispectral Index (BIS) has been calibrated for several general anaesthetic agents including isoflurane. Halothane is still used in paediatric anaesthesia. Compared with other volatile anaesthetics, halothane has a different receptor affinity and differing effects on the EEG. There are limited data evaluating the BIS with halothane. We set out to compare the BIS using halothane and isoflurane at a clinically relevant equipotent concentration (1 MAC) and at a reproducible measure of anaesthetic effect (awakening). METHODS: Forty children aged between 2 and 15 yr were enrolled in a masked randomized trial-20 in each group. Anaesthesia was induced with sevoflurane or propofol. Either halothane or isoflurane were given to obtain an end-tidal concentration of 1 MAC for 15 min. The BIS was then recorded. The BIS was also recorded at awakening. Values (mean (SD)) were compared with a t test. RESULTS: At 1 MAC the BIS for halothane was significantly greater than isoflurane (56.5 (8.1) vs 35.9 (8.5), P<0.0001). At awakening there was no significant difference (BIS halothane; 81.1 (11.9), BIS isoflurane; 82.5 (16.4)). The difference in means at awakening was 1.4 (95% CI -8.2 to 11.1). CONCLUSIONS: At equipotent concentrations of halothane and isoflurane BIS valves were significantly greater with halothane. At awakening the BIS values were equivalent for each agent. This finding is consistent with the BIS being more affected by the agent used at higher concentrations of anaesthetic. The BIS must be interpreted with caution when using halothane.

A 10-year prospective study of patients with skin cancer.

BACKGROUND AND OBJECTIVE: To determine the incidence of new skin cancer formation in people who have had a nonmelanoma skin cancer (NMSC) removed. METHODS: A prospective study of Australian outpatients with histologically confirmed nonmelanoma skin cancer (NMSC). RESULTS: Four hundred eighty-one patients were entered in the study and 300 were followed for at least 10 years. Another skin cancer developed in 67.8% and multiple skin cancers (three or more) in 51.8%. A logistical regression analysis found that the main risk factors for new skin cancer formation were male sex and if the patient had multiple skin cancers. A squamous cell carcinoma (SCC) developed in 36% during the study and a melanoma in 4.7% of men and 2.1% of women. Men who had a NMSC were 8 times more likely than the general population to develop a melanoma while women with NMSC were 4 times more likely. Three patients died of metastatic SCC and one of metastatic melanoma during the followup period. A multivariate analysis showed that multiple skin cancer formation was the main risk factor for SCC or melanoma formation. CONCLUSION: Patients with NMSC require careful followup as they have an increased risk of new cancer formation. Those with multiple skin cancer merit particularly careful followup as all develop another NMSC within 10 years and have a significantly increased risk of developing SCC or melanoma.

A student-run Geriatric Home Health Care Program.

This paper describes how medical students developed, maintained, and received curriculum credit for a home health care program for senior citizens, and how both patients and students have benefited from the program.

Influence of exogenous T4 on body weight, feed consumption, T4 levels, and myocardial glycogen in furazolidone-fed turkey poults.

Ten turkey poults each were placed in one of four groups: control, thyroxine (T4), furazolidone (FZ), and FZ + T4. Thyroxine (T4), at a concentration of 1 ppm, was included in the ration of poults fed T4 and FZ + T4, and furazolidone (FZ), at a concentration of 700 ppm, was included in the ration of poults fed FZ and FZ + T4 from 2 to 5 weeks of age. Levels of plasma T4 decreased significantly (P less than or equal to 0.05) between 2 and 5 weeks in control and FZ poults. At 5 weeks, plasma T4 levels were significantly (P less than or equal to 0.05) lower in FZ poults than in control poults and significantly (P less than or equal to 0.05) lower in the FZ + T4 poults than in the T4 poults. Exogenous administration of T4 had no effect on development of the round heart syndrome or on body weight, but significantly increased feed consumption in FZ-fed poults during weeks 4 (P less than or equal to 0.05) and 5 (P less than or equal to 0.01). Inclusion of T4 in the ration increased plasma levels of the hormone 12x in both T4 and FZ + T4 poults and significantly (P less than or equal to 0.05) increased myocardial glycogen content in T4 poults but not in FZ + T4 poults.

Effect of including lasalocid or monensin singly or in combination with furazolidone on the growth and feed consumption of turkey poults.

Lasalocid and monensin are widely used to control coccidiosis in broilers, but not in turkey poults. Four feeding trials were conducted to determine the performance of turkey poults when these compounds were used singly or in combination with 100 ppm of furazolidone. Bodyweights and feed consumption were significantly depressed for five weeks after hatching by 150 ppm of lasalocid. Combining furazolidone with lasalocid ameliorated the toxic effect of lasalocid. Bodyweights were significantly depressed by 150 ppm of monensin in the fifth week after hatching, but there was no significant depression in feed consumption. Furazolidone exacerbated any toxic effects of monensin. Data indicate that monensin may be used safely at dosages greater than the recommended level of 60 to 99 ppm, but should not be used in combination with furazolidone.

Furazolidone toxicity in neomycin-treated turkey poults.

Furazolidone (FZ) toxicity was evaluated in turkey poults treated with neomycin at a dose of 20 mg/kg body weight for 5, 10, or 26 days. Neomycin treatment had no effect on FZ-induced anorexia, delayed the onset of altered electrocardiographic patterns by approximately 1 week, and did not significantly affect the development of FZ-induced cardiomyopathy. Data indicated that FZ toxicity is not significantly altered by the gut microflora.

Toxicity of 1,2-diethylhydrazine fed to turkey poults.

Toxic effects of 1,2-diethylhydrazine, a putative furazolidone metabolite, were determined in turkey poults 2 to 5 weeks of age. The drug was administered either in the drinking water or by gastric intubation. Toxic effects included depression of growth, decreased feed intake, and increased feed conversion. There was no evidence of an induced cardiomyopathy. These findings indicate that the etiology of furazolidone toxicity involves more than one mechanism.

Toxicity of 2-hydrazinoethanol in turkey poults.

1. Toxicity of 2-hydrazinoethanol was investigated in turkey poults 2-6 weeks posthatch. 2. Significant depression of body wt was evident at concentrations of the drug as low as 10 ppm. 3. Severe anorexia closely paralleled a highly significant decrease in water intake. 4. A significant increase in the ratio of granulocytes to agranulocytes was seen in poults fed the drug at a dose of 50 ppm. 5. Under the conditions of this experiment, none of the tissues sampled exhibited pathologic changes consistent with drug injury.

Influence of thiamin supplements on furazolidone-induced cardiomyopathy in turkey poults.

Furazolidone (700 ppm) was fed to turkey poults from 2 to 5 weeks of age. The drug produced a cardiomyopathy and reduced the feed intake and growth of the birds. Thiamin was concurrently injected into the furazolidone-fed poults to determine whether the vitamin would prevent or reduce the severity of the cardiotoxic effect of the drug. Supplemental injections of thiamin had no significant effect on feed consumption or growth of the birds nor did they protect the heart against the cardiotoxicity. The conclusion is that furazolidone-induced cardiomyopathy is not caused by a thiamin deficiency.

Ethanol-induced alteration in thiamin status of young turkey poults.

The effect of ethanol on thiamin status was determined in the turkey poult, a new animal model for alcohol-induced cardiomyopathy in humans. The poults were given ethanol (4 to 5% v/v) in the drinking water for six weeks post-hatch. This treatment decreased body weights and increased significantly the relative weights of the hearts. Ethanol consumption increased significantly the blood concentrations of pyruvate and lactate, decreased the activity of erythrocyte transketolase (TK), and increased the stimulation of TK activity of thiamin pyrophosphate (TPP) in lyzed blood cells (TPP effect). These findings indicate that ethanol treatment has an adverse effect on the thiamin status of the turkey poult.

Plasma triglyceride levels in ethanol-fed turkey poults.

Plasma triglyceride levels were determined in ethanol-fed turkey poults at 24 and 38 days posthatch. Ethanol, fed at concentrations of 4, 4.5 and 5% during the first, second and third weeks, respectively, significantly (P less than or equal to 0.5) elevated plasma triglyceride levels. Significantly (P less than or equal to 0.05) increased levels of plasma triglyceride were maintained with continued feeding of 5% ethanol during the fourth and fifth weeks. A significantly (P less than or equal to 0.01) increased ratio of heart weight to body weight in the ethanol-fed poults confirmed the presence of an ethanol-induced cardiomegaly.

The effect of thiamin supplementation on the thiamin status of turkey poults with ethanol-induced cardiomegaly.

1. Turkey poults were treated with graded doses (0-5% v/v) of ethanol for 6 weeks. Some birds were concomitantly injected intramuscularly with thiamin. 2. Erythrocyte transketolase (TK) activity was significantly decreased and the erythrocyte pyrophosphate (TPP) effect and blood concentrations of lactate and pyruvate were statistically greater in all ethanol-treated poults by 42 days. 3. Thiamin restored TK activity to normal levels and decreased the TPP effect and blood concentrations of lactate and pyruvate in ethanol poults. 4. Thiamin mitigated ethanol-induced cardiomyopathy in some 4-5% ethanol poults. 5. Thiamin had no significant effect on any of these parameters in control birds treated with thiamin.

Myocardial levels of calcium, glycogen and triglycerides in ethanol-fed turkey poults treated with allopurinol.

Effect of allopurinol treatment on myocardial levels of calcium, glycogen and triglyceride and on plasma levels of triglyceride was evaluated in turkey poults during a period of chronic ethanol consumption and following a period of ethanol abstinence. Allopurinol treatment had no significant effect on myocardial levels of calcium. Allopurinol treatment plus abstinence was slightly more effective than abstinence alone in restoring myocardial levels of glycogen and triglyceride and plasma levels of triglyceride in ethanol-fed poults to that seen in control poults.

Plasma uric acid levels in ethanol-fed turkey poults treated with allopurinol.

Plasma uric acid levels were determined in ethanol-fed poults following administration of allopurinol. In young poults, allopurinol at a dose of 50 mg/kg significantly depressed plasma uric acid levels 6 hr post-dosing. At 11 hr post-dosing, plasma uric acid levels were significantly elevated in the allopurinol-treated poults when compared with control poults. During a period of ethanol abstinence, allopurinol at a dose of 40 mg/kg significantly depressed plasma uric acid levels up to 8 hr post-dosing. At a dose of 30 mg/kg, plasma uric acid levels were similar to control values at 4 and 6 hr post-dosing. Data suggest that plasma uric acid levels can be depressed in ethanol poults when allopurinol is administered every 8 hr at a dose of 40-50 mg/kg of body weight.