Relationships between eye fluids and blood values after exercise in lidia cattle: mineral parameters.

Eye fluids (aqueous humour and vitreous humour) may be helpful in estimating ante-mortem blood levels, since some parameters measured in these fluids have proved to be stable or to change in a predictable way after death. This would help in diagnosing the cause of death in some diseases or to evaluate ante-mortem blood levels in certain animals not easy to handle or with difficult access. In order to establish reference values of some parameters in blood and eye fluids (aqueous humour and vitreous humour), as well as the possible correlation among these three different fluids, various minerals and electrolytes (Ca, P, Mg, K, Na, Fe, Cr, Co, Ni, Cu, Zn, Se and Mo) were measured in 15 four to five year-old Lidia bulls, all dying after a period of significant stress and major exertion. Plasmatic values of Mg and P were much greater than reported in the literature. In general, mineral plasmatic values were greater than those found in ocular fluids (aqueous and vitreous), while Na, K and Cr were similar in the three fluids. We have verified the existence of correlations in P, Co and Mo among the three fluids measured, and between Se of plasma and vitreous humour. But the most marked correlations were observed in Mo (plasma -aqueous humour, r = 0.893, plasma-vitreous humour, r = 0.945, HA -HV, r = 0.849), in P (plasma-vitreous humour, r = 0.726) and in Co (plasma-vitreous humour, r = 879).

Predictors of outcome in 101 patients requiring emergent thoracotomy for penetrating pulmonary injuries.

BACKGROUND: Operative interventions are uncommonly required for penetrating pulmonary injuries. Similarly, because their incidence is low, few series appear sporadically in the literature. Objectives of this study are to identify predictors of outcome for patients requiring emergent thoracotomy for penetrating pulmonary injuries and evaluate the use of tissue sparing versus resective techniques for their management. STUDY DESIGN: This is a retrospective 169-month study of all patients with penetrating pulmonary injuries requiring thoracotomy. The main outcome measures are: physiologic parameters, AAST-OIS injury grade, surgical procedures and mortality. Statistical analysis includes univariate and stepwise logistic regression. RESULTS: 101 patients required thoracotomy for penetrating pulmonary injuries. Mechanism of injury includes: gunshot wounds (GSW)-73 (72%), stab wounds (SW)-28 (33%). Mean systolic BP 97 ± 47, mean HR 92 ± 47, and mean admission pH 7.22 ± 0.17. Mean RTS 6.25 ± 2.7, mean ISS 36 ± 22. The mean estimated blood loss (EBL) was 5277 ± 4955 mls. Predictors of outcome are: admission pH (p = 0.0014), admission base deficit (p < 0.0001), packed red blood cells (PRBCs) transfused (p = 0.023), whole blood transfused (p < 0.01). A total of 143 procedures were required in 101 patients: tissue sparing 114 (80%) versus resective procedures 29 (20%). Only pneumonectomy (p = 0.024) predicted outcome. Overall survival 64/101-64%. American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) injury grades I-III versus IV-VI predicts survival (p < 0.001). Stepwise logistic regression identified AAST-OIS injury grades IV-VI (p = 0.007; OR 6.38 [95% CI 1.64-24.78]), intraoperative dysrhythmias (p = 0.003; OR 17.38 [95% CI 2.59-116.49]) and associated cardiac injuries (p = 0.02; OR 8.74 [95% CI 1.37-55.79]) as independent predictors of outcome. CONCLUSIONS: Predictors of outcome for penetrating pulmonary injuries requiring thoracotomy are identified and must be taken into account in their operative management. Tissue sparing techniques-stapled pulmonary tractotomy is once again validated, and it remains effective as the mainstay for their management; however, only pneumonectomy predicts outcome. AAST-OIS injury grades IV-VI predict outcome with higher injury grades requiring resective procedures.

Penetrating cardiac injuries: predictive model for outcomes based on 2016 patients from the National Trauma Data Bank.

BACKGROUND: Penetrating cardiac injuries are uncommon and lethal. The objectives of this study are to examine the national profile of cardiac injuries, identify independent predictors of outcome, generate, compare and validate previous predictive models for outcomes. We hypothesized that National Trauma Data Bank (NTDB) given its large number of patients, would validate these models. METHODS: The NTDB was queried for data on cardiac injuries, using survival as the main outcome measure. Statistical analysis was performed utilizing univariate and stepwise logistic regression. The stepwise logistic regression model was then compared with other predictive models of outcome. RESULTS: There were 2016 patients with penetrating cardiac injuries identified from 1,310,720 patients. Incidence: 0.16%. Mechanism of injury: GSWs-1264 (63%), SWs-716 (36%), Shotgun/impalement-19/16 (1%). Mean RTS 1.75, mean ISS 27 ± 23. Overall survival 675 (33%). 830 patients (41%) underwent ED thoracotomy, 47 survived (6%). Survival stratified by mechanism: GSWs 114/1264 (10%), SWs 564/717 (76%). Predictors of outcome for mortality-univariate analysis: vital signs, RTS, ISS, GCS: Field CPR, ED intubation, ED thoracotomy and aortic cross-clamping (p < 0.001). Stepwise logistic regression identified cardiac GSW's (p < 0.001; AOR 26.85; 95% CI 17.21-41.89), field CPR (p = 0.003; AOR 3.65; 95% CI 1.53-8.69), the absence of spontaneous ventilation (p = 0.008; AOR 1.08, 95% CI 1.02-1.14), the presence of an associated abdominal GSW (p = 0.009; AOR 2.58, 95% CI 1.26-5.26) need for ED airway (p = 0.0003 AOR 1386.30; 95% CI 126.0-15251.71) and aortic cross-clamping (p = 0.0003 AOR 0.18; 95% CI 0.11-0.28) as independent predictors for mortality. Overall predictive power of model-93%. CONCLUSION: Predictors of outcome were identified. Overall survival rates are lower than prospective studies report. Predictive model from NTDB generated larger number of strong independent predictors of outcomes, correlated and validated previous predictive models.

Nephrotic syndrome due to thrombotic microangiopathy (TMA) as the first manifestation of human immunodeficiency virus infection: recovery before antiretroviral therapy without specific treatment against TMA.

BACKGROUND: Among the possible renal complications that can develop a human immunodeficiency virus- (HIV) infected patient, thrombotic microangiopathy (TMA) is one of them. This is a type of vascular lesion more common in HIV patients than in normal population, and sometimes it can be the first manifestation of the HIV infection. METHODS: We present a patient with TMA in whom the subsequent investigation to find the cause of TMA revealed HIV infection and Giardia Lamblia in stool. RESULTS: Before antiretroviral therapy was started the patient began to show recovery of the hemolytic anemia, recovery of the nephrotic syndrome and partial remission of the proteinuria, so that he did not receive specific therapy for TMA. CONCLUSIONS: HIV infection should be suspected in patients presenting with TMA, and a HIV test should be routinely performed as part of the initial clinical evaluation of TMA. If the patients have not developed acquired immunodeficiency syndrome, the prognosis of TMA is equal to non-infected ones.

[Idiopathic partial epilepsy syndromes]. / Síndromes epilépticos parciales idiopáticos.

OBJECTIVE: In this paper we wish to review the main characteristics of idiopathic partial epilepsy syndromes recognized in the International Classification of epilepsies and epileptic syndromes and of other syndromes which have been described but not yet included in this classification, with special emphasis on the clinical condition, electroencephalographic aspects and progress. DEVELOPMENT: The idiopathic partial epileptic syndromes are characterized by the absence of a subjacent cerebral lesion and neurological or intellectual deficit. In most cases there is a definite genetic predisposition. There is often a family history of benign epilepsy. The seizures usually start after the age of 18 months. The interictal EEG shows basically normal activity but focal epileptic discharges are often seen. CONCLUSIONS: There are many idiopathic partial epileptic syndromes. However, most of them are not included in the International Classification of the epilepsies and epileptic syndromes. We believe that further study is necessary and consider that when more cases are reported and with continual advance of genetic studies there will be a consequent improvement in understanding of these syndromes and they will be included in the International Classification of epilepsies and epileptic syndromes.

[Reflex anoxic cerebral crises in children]. / Crisis cerebrales anóxicas reflejas en el niño.

OBJECTIVE: Reflex anoxic cerebral crises are due to depression of nerve function caused by a vagotonic state or vagal hypersensitivity. In this paper we propose to review the physiopathology, clinical features and diagnostic procedures of these crises. DEVELOPMENT: There are three types of reflex anoxic cerebral crises: asphyxiating anoxic crises, ischemic anoxic crises and asphyxiating-ischemic anoxic crises. They are caused by sudden activation of the so-called syncopal reflex. They are characterized by diverse clinical manifestations and may often be mistaken for epileptic crises. They are related to various precipitating factors such as a blow, often to the head, an emotional stimulus or something which upsets or molests, hyperthermia, abdominal pain, headache, physical exertion, prolonged standing-up, exposure to heat, the sight of blood, feeling of fear and other factors. CONCLUSIONS: Important elements for the diagnosis of these crises are the presence of a family history of vagal crises, the presence of precipitating factors, brief duration of the crises (seconds) in most patients, and clinical signs of facial or perioral pallor or cyanosis. The test involving pressure on the eyeball and the tilting table are useful for diagnosis. However, they should be used sensibly.

[Ischemic anoxic cerebral crises in children. Electrophysiological aspects]. / Crisis cerebrales anóxicas isquémicas en el niño. Aspectos electrofisiológicos.

INTRODUCTION: Ischemic anoxic cerebral crises are linked to cardio-inhibition in response to vagal hypersensitivity which causes cerebral ischemic. OBJECTIVE: In this paper we proposed to describe the clinical and electrophysiological features seen during the ocular compression test. PATIENTS AND METHODS: We studied 200 children with clinical findings suggesting ischemic anoxic cerebral crises with positive results on ocular compression testing. RESULTS: The ocular compression test provoked signs and symptoms, on average, in between 48.5% and 62.5% of the patients; generalized hypotonia and loss of consciousness were the most frequent signs. We found that the presence of clinical changes depended on the duration of the pause in heartbeat. There was also an association between the duration of the pause in heartbeat and the electroencephalographic findings. CONCLUSIONS: Identification of a state of vagal hypersensitivity is of considerable value in the positive differential diagnosis of cerebral crises in children, and of definite prognostic value.

Vascular complications and special problems in vascular trauma.

The evaluation and management of patients with vascular trauma or injury often involve rapid decision making in less than ideal circumstances. Immediate consequences such as hemorrhage, ischemia, compartment syndrome, thrombosis, and embolization may be life threatening and require immediate intervention. In addition, a number of regional and systemic complications of the initial vascular pathology are possible, such as shock, acute renal failure, myocardial infarction, or stroke. Understanding the disease process, as well as the optimal diagnostic and therapeutic interventions, is critically important to minimize the risk of these highly morbid or potentially mortal complications. The managing physician must be adept and well versed at both the initial management of the specific vascular injury and the many potential complications that may subsequently arise. This article will review a number of vascular-specific complications and provide details of strategies for their prevention or optimal management. These problems include traumatic injuries to the arterial or venous system, failure of vascular repairs or reconstructions, surgical site and graft infections, anastomotic complications, and compartment syndromes. In addition, arterial and venous complications secondary to the use of illicit intravenous drug use and cocaine-related vascular injury will be discussed. Finally, the increasingly important topic of iatrogenic or procedure-related vascular injuries and complications will be reviewed.

Popliteal vessel injuries: complex anatomy, difficult problems and surgical challenges.

The incidence of popliteal vessel injuries is low, even in busy urban trauma centers. As a result of this fact, few trauma centers and trauma surgeons have developed extensive experience in the management of these injuries. Popliteal vessel injuries in both civilian and military arenas incur significant morbidity. These injuries present a difficult challenge, and, although the overall incidence of these injuries remains low, the sequelae can be devastating. Successful outcomes for limb salvage and survival result from early recognition and rapid surgical intervention by a multidisciplinary approach with a great participation of different surgical specialties. From the historical perspective, anatomy, incidence and associated injuries, to the clinical presentation, diagnosis, management, and morbidity and mortality, the aim of this article is to review the various aspects of these complex injuries.

Iliac vessel injuries: difficult injuries and difficult management problems.

INTRODUCTION: Injury to the iliac vessels poses a serious and frustrating treatment dilemma for all trauma surgeons. Generally, patients present in profound shock secondary to severe hemorrhage from either iliac arterial, venous, or combined injuries. Despite improvements in our emergency medical services (EMS), rapid transport, standard training of trauma surgeons, and improved technology, the morbidity and mortality from iliac vessel injuries remain high, ranging from 25 to 40 %. MATERIALS AND METHODS: A systematic review of the literature, with emphasis placed on the diagnosis, treatment, and outcomes of these injuries, incorporating the author's experience. CONCLUSIONS: Injuries to the iliac vessel remain a daunting task, even after great advances in anatomic injury grading and damage control as well as advances in surgical techniques and critical care. Despite all the advances in treatment and appropriate management strategies, the morbidity and mortality from iliac vessel injuries remain high, demonstrating the complex challenge their treatment presents to even the modern-day trauma surgeon.

Femoral vessel injuries; high mortality and low morbidity injuries.

Femoral vessel injuries are amongst the most common vascular injuries admited in busy trauma centers. The evolution of violence and the increase in penetrating trauma from the urban battlefields of city streets has raised the incidence of femoral vessel injuries, which account for approximately 70% of all peripheral vascular injuries. Despite the relatively low mortality associated with these injuries, there is a high level of technical complexity required for the performance of these repairs. Similarly, they incur low mortality but are associated with significantly high morbidity. Prompt diagnosis and treatment are the keys to successful outcomes with the main goals of managing ischemia time, restoring limb perfusion, accomplishing limb salvage and instituting rehabilitation as soon as possible.

Shank vessel injuries: the forgotten vascular injuries.

INTRODUCTION: Vascular injuries in branch vessels of the popliteal artery, such as the tibioperoneal trunk, and shank vessels, such as anterior, posterior tibial, and peroneal vessels, occur in both blunt and penetrating trauma. Their management has evolved significantly in the past few decades. While their incidence is variable, limb loss and morbidity remain significant. MATERIAL AND METHODS: Physical examination, along with measuring an Ankle-Brachial Index (ABI), is still sometimes all that is required for diagnosis and can expeditiously triage those that require urgent operation. Despite our technological advancements and newer algorithms for lower extremity vascular trauma, operative intervention and exposure still remain difficult and pose a great challenge for surgeons that normally do not operate on this area. CONCLUSIONS: Shank vessel injuries still comprise a significant proportion of combat and civilian vascular injuries, and modern advances have led to a dramatic decrease in amputation rates.

The effects of age and reproductive status on serum and blood parameters in merino breed sheep.

Merino breed female sheep (225 in total) were used to study the effects of age and reproductive state on the values of 31 physiological parameters. Of these 31 parameters, 23 were affected by the age of animals, by their reproductive state, or by the interaction between these two factors. The statistical weighing of each of the factors of variability was determined. This revealed that the effects produced by them were indeed systematic. In order to demonstrate the systematic nature of the factors of variability, an attempt was made to classify each animal with respect to its reproductive state and age group, given only the set of biochemical values relating to it. The number of correct assignments to an age group achieved was 84.41%, and this rose to 92.17% with regard to reproductive state. A figure of 100% of correct assignments was reached with the adult age group and animals in oestrus. Thus, although the range of values observed for physiological parameters can, on occasions, be very large, this must be seen as a result of physiological deviations from average. These deviations are systematic and quantifiable, whether analysed in isolation or together as part of a multivariate analysis.

[Validation of the chronometer test as a method of screening for hypoacusis in patients aged 65 years and older]. / Validación del test del cronómetro como método de cribaje de hipoacusias en pacientes de más de 65 años.

OBJECTIVE: Evaluation of the chronometry test as a screening procedure for hypoacusia compared with tonal audiometry, in patients over 65 years. DESIGN: Cross-sectional study. SETTING: Mariañamansa health area (Ourense). PATIENTS: The first 49 patients over 65 who came to the medical consultations in June and July 1992 were selected, irrespective of the reasons for their visit; there were 17 males and 32 females, with and average age of 72.4 +/- 4.6 and 71.9 +/- 4.5. Only one patients consulted directly about loss of hearing. MEASUREMENTS AND MAIN RESULTS: A statistically significant association was found between the chronometry test and the audiometry test (gold-standard), significant at p < 0.005 for the left ear and p < 0.05 for the right ear. The test achieved a sensitivity of 0.85 and specificity of 0.76 in the case of the left ear, and 0.84 (sensitivity) and 0.56 (specificity) for the right ear. The kappa rate was 0.55 for the right ear and 0.67 for the left ear, showing agreement that went well beyond chance. CONCLUSIONS: In our view, the chronometry test constitutes an cheap, effective, simple, and replicable procedure for the detection of hypoacusia in patients aged over 65, and one which can usefully be used when no audioscope is available.