Comparison of Metallic Foreign-Body Removal between Dynamic Ultrasound and Static Radiography in a Pigs' Feet Model.

INTRODUCTION: We compared the immediate cosmetic outcome of metallic foreign-body removal by emergency medicine (EM) residents with ultrasound guidance and conventional radiography. METHODS: This single-blinded, randomized, crossover study evaluated the ability of EM residents to remove metallic pins embedded in pigs' feet. Before the experiment, we embedded 1.5-cm metallic pins into numbered pigs' feet. We randomly assigned 14 EM residents to use either ultrasound or radiography to help remove the foreign body. Residents had minimal ultrasound experience. After a brief lecture, we provided residents with a scalpel, laceration kit, a bedside portable ultrasound machine, nipple markers, paper clips, a dedicated radiograph technician, and radiograph machine 20 feet away. After removal, 3 board-certified emergency physicians, who were blinded to the study group, evaluated the soft-tissue model by using a standardized form. They recorded incision length and cosmetic appearance on the Visual Analog Scale. RESULTS: In total, 28 foreign bodies were removed. No significant difference in the time of removal (P = 0.12), cosmetic appearance (P = 0.96), or incision length (P = 0.76) was found. CONCLUSION: This study showed no difference between bedside ultrasound and radiography in assisting EM residents with metallic foreign-body removal from soft tissue. No significant difference was found in removal time or cosmetic outcome when comparing ultrasound with radiography.

The utility of bedside ultrasound in the detection of a ruptured globe in a porcine model.

BACKGROUND: Recent case reports have shown that ultrasonography can be used to diagnose ocular pathology in an emergency setting. Ultrasound may be especially useful when periorbital edema and pain interfere with the examination of the post-traumatic eye. OBJECTIVE: This study evaluated the ability of emergency physicians to detect a ruptured globe in an ex-vivo porcine model. METHODS: Following a brief training lecture, 15 emergency medicine residents and 4 emergency medicine attending physicians used ultrasonography to evaluate 18 porcine eyes, randomized as normal, ruptured, or completely devoid of vitreous humor. The consequences of ultrasound applanation with this method were evaluated by measuring intraocular pressure changes with and without a 1mm clear plastic shield. RESULTS: Our study participants were able to identify abnormal eyes with a sensitivity of 79% (95% CI 73% to 84%) and a specificity of 51% (95% CI 41% to 61%). Intraocular pressure increased 5% with ultrasound applanation, though with a 1mm thick plastic shield there was no measurable change. CONCLUSIONS: Ultrasound imaging may be a future modality to be used by trained emergency physicians to expedite the identification of a rupture globe, but it is unlikely to replace more definitive imaging techniques. The use of a clear plastic barrier in this porcine model prevents an increase in intra-ocular pressure without affecting image quality, and should be used in any future studies on this method.

Acute myocardial infarction in pregnancy and the puerperium: a population-based study.

OBJECTIVE: To estimate the population-based incidence and pregnancy outcomes of acute myocardial infarction (MI) in pregnancy. METHODS: Maternal and newborn hospital discharge records were linked to birth/death certificates for the 10-year period January 1, 1991, to December 30, 2000, for the majority (98%) of deliveries in California. This database was searched for the diagnosis of acute MI, demographic characteristics, and pregnancy outcomes. Patients were divided into 4 groups: antenatal diagnosis, intrapartum diagnosis, up to 6-week postpartum diagnosis, and those without the diagnosis of acute MI. All groups were compared by Student t test or chi(2) or both, where appropriate. RESULTS: A total of 151 women had an acute MI during the antepartum (38%), intrapartum (21%), or 6-week postpartum (41%) period, giving an incidence rate of 1 in 35,700 deliveries. The incidence rate increased over the study period. The maternal mortality rate was 7.3%, and maternal death only occurred in women with an acute MI before or at delivery (P < .01). Compared with women who did not have an acute MI, those with one were more likely to be older (30% were older than 35 years compared with 10%), multiparous (78% compared with 61%), non-Hispanic white (40% compared with 35%) or African Americans (15% compared with 7%). All measures of maternal and neonatal morbidity were increased in the acute MI group compared with those without an acute MI. Multivariate analysis identified chronic hypertension, diabetes, advancing maternal age, eclampsia, and severe preeclampsia as independent risk factors for acute MI. CONCLUSION: Acute MI during pregnancy remains a rare event, with significant maternal, fetal, and neonatal morbidity and mortality and maternal mortality limited to the antepartum and intrapartum period.

Genome sequence of the hyperthermophilic crenarchaeon Pyrobaculum aerophilum.

We determined and annotated the complete 2.2-megabase genome sequence of Pyrobaculum aerophilum, a facultatively aerobic nitrate-reducing hyperthermophilic (T(opt) = 100 degrees C) crenarchaeon. Clues were found suggesting explanations of the organism's surprising intolerance to sulfur, which may aid in the development of methods for genetic studies of the organism. Many interesting features worthy of further genetic studies were revealed. Whole genome computational analysis confirmed experiments showing that P. aerophilum (and perhaps all crenarchaea) lack 5' untranslated regions in their mRNAs and thus appear not to use a ribosome-binding site (Shine-Dalgarno)-based mechanism for translation initiation at the 5' end of transcripts. Inspection of the lengths and distribution of mononucleotide repeat-tracts revealed some interesting features. For instance, it was seen that mononucleotide repeat-tracts of Gs (or Cs) are highly unstable, a pattern expected for an organism deficient in mismatch repair. This result, together with an independent study on mutation rates, suggests a "mutator" phenotype.