Trauma to the Superior Mesenteric Artery and Superior Mesenteric Vein: A Narrative Review of Rare but Lethal Injuries.

Mesenteric vessels, including the superior mesenteric artery (SMA) and vein (SMV), provide and drain the rich blood supply of the midgut and hindgut. SMA and SMV injuries are rare and often lethal. Clinical management of these injuries is not well established, but treatment options include operative, non-operative, and endovascular strategies. A narrative review of the literature was conducted using MEDLINE Complete-EBSCO. Relevant studies, specifically those focusing on diagnosis and management of SMA and SMV injuries, were selected. Only original reports and collected series were selected to prevent duplication of cases. A search of the literature for mesenteric arterial injuries yielded 87 studies. Vessel-specific breakdown of the studies yielded 40 with SMA injuries and 41 with SMV injuries. These searches were winnowed to 26 individual studies, which were included in this collective review. Limitations of this study are similar to all narrative literature reviews: the dependence on previously published research and availability of references as outlined in our methodology. Although historically rare, mesenteric vessel injuries are seen with increasing incidence and continue to present a challenge to trauma surgeons due to their daunting mortality rates. Currently, universal treatment guidelines do not exist, but the various options for their management have been extensively reviewed in the literature.

Comparison of methods for personal sampling of inhalable and total lead and cadmium-containing aerosols in a primary lead smelter.

It has been proposed that future occupational aerosol exposure standards be based on particle size-selective sampling criteria that more accurately reflect worker exposure. In relation to methods currently used for determining individual workers' lead exposures, the widely used 37-mm, closed-face, plastic sampling cassette is known from laboratory wind tunnel studies to undersample significantly compared with estimations of aerosol actually inhaled, especially for large particles. The present study investigated the degree to which this is borne out in field sampling by using side-by-side sampling in selected work sites in a primary lead smelter. Exposures to "total" airborne lead and cadmium as measured using the 37-mm sampler (E37) were compared with exposure measurements using the institute of Occupational Medicine (IOM) personal inhalable aerosol sampler (EIOM). There were 166 good sample pairs for lead and 55 for cadmium. The ratio (reflecting the fractional undersampling of the 37-mm sampler, as represented by the ratio EIOM/E37) was consistently greater than unity, by factors obtained by regression analysis ranging (for different parts of the plant) from 1.39 to 2.14 for lead and 1.29 to 2.12 for cadmium. The factor tended to be greater for parts of the plant characterized by coarser aerosol, consistent with the physical sampling characteristics of the two instruments. This research is important (1) in assessing the impact of implementation of new standards for lead- and cadmium-containing aerosols in the primary lead production industry, and (2) in the development of new occupational exposure limits based on the inhalable aerosol fraction.