AAC Technologies with Visual Scene Displays and "Just in Time" Programming and Symbolic Communication Turns Expressed by Students with Severe Disability.

Background: The current study investigated the impact of an intervention that included aided augmentative and alternative communication (AAC) technologies on the frequency of symbolic communication turns of school-age children, adolescents, and young adults with severe disability.

Method: Nine students ages 8-20 were engaged in interactive activities using an aided AAC system with visual scene displays (VSDs; concepts embedded within a photograph of a naturally occurring event), and "just-in-time" (JIT) programming (the capability to add new contexts "on the fly"). Effectiveness was evaluated using a single subject multiple probe across participants design.

Assessment of parameters influencing the blood flow velocities in cerebral arteries of the rat using ultrasonographic examination.

Objectives: Rat models of cerebrovascular diseases are used for a variety of human pathologies comprising ischemic stroke or subarachnoid hemorrhage. Whereas in neuro-intensive care, Doppler ultrasonographic examination of major cerebral arteries is a common diagnostic tool, only few data exist concerning the animal model. We therefore studied cerebral blood flow velocities in the rat by ultrasonographic triplex mode.

Feasibility of laparoscopic management of acute haemoperitoneum secondary to ruptured ovarian cysts in a haemodynamically unstable patient.

Acute haemoperitoneum in patients with coagulation disorders or those under anticoagulation therapy is a diagnostic and therapeutic dilemma. Since radiological imaging is often insufficient for establishing the origin of the bleeding, a laparoscopic approach can be considered before a laparotomy is performed in haemodynamically unstable patients. A 32-year-old woman receiving coumadin therapy presented with acute lower abdominal complaints.

Inflammatory complications following penetrating cardiac trauma.

Two cases with pericardial and myocardial inflammatory complications following penetrating cardiac trauma are presented. A high index of suspicion with liberal usage of echocardiography, serial electrocardiograms, and careful patient follow-up will preclude this diagnostic oversight.

Beneficial effects of diltiazem in hemorrhagic shock.

The role of calcium channel blockade on metabolic alterations in a hemorrhagic shock model was studied. Experiments were performed on anesthetized Sprague-Dawley rats to evaluate the effect of diltiazem on hyperglycemia and hyperlacticacidemia following hemorrhagic shock. Rats were bled rapidly to a blood pressure of 40 mm Hg and maintained at that level for 2 hr.

Paraparesis following emergency room thoracotomy: case report.

Spinal cord ischemia complicating resuscitative aortic occlusion is reported in a patient requiring emergency thoracotomy and aortic cross-clamping following a stab wound to the heart. Paraparesis and ischemic myelopathy were documented in the absence of associated injury. The possible contribution of systemic hypotension to spinal cord ischemia following aortic occlusion is suggested.

Preventable deaths in a self-designated trauma system.

Organized paramedic care was established in 1974 in Hillsborough County, Florida, with subsequent development of a hospital self-designation system for trauma in 1980. To evaluate the level of trauma care in the county, a review of trauma deaths in 1984 was performed. A total of 452 trauma deaths was identified.

Hemodynamic, renal, and hormonal responses to incremental ANF infusions in humans.

The effects of incremental exogenous alpha-human atrial natriuretic factor (ANF) infusion (10 and 25 ng.kg-1. min-1) on the cardiovascular, renal, and hormonal systems were examined in 22 healthy males.

Blunt pancreatic trauma: prospective evaluation of early endoscopic retrograde pancreatography.

Major ductal injury is a determining factor in the outcome after pancreatic trauma. The purpose of this study was to determine the value of early endoscopic retrograde pancreatography (ERP) in patients with blunt pancreatic trauma. We attempted ERP in nine patients.

A prospective evaluation of field categorization of trauma patients.

We prospectively evaluated the efficacy of comprehensive field triage in 8,891 trauma patients transported to trauma centers in Dade County, Florida, over a 1-year period ending in September 1986. There were 5,685 males (63.9%) and 3,206 females (36.

Diagnostic peritoneal lavage for blunt abdominal trauma: an unusual result.

We have reported the unusual finding of a grossly bile-stained peritoneal lavage 24 hours after blunt abdominal trauma, associated with neither enteric, hepatic, nor biliary tract injury at laparotomy. Intraoperative transcholecystic cholangiography is recommended in such a situation to rule out biliary tract injury.

Diagnosis related groups and the critically injured.

We reviewed the records of 59 patients with trauma treated in the surgical intensive care unit in 1983 to attempt to identify a diagnosis related group (DRG) modifier in order to eliminate major losses which would be incurred in caring for the critically injured. There were 22 females and 37 males. Payment based upon a DRG system would have resulted in hospital losses for the following subgroups: surgical treatment (n = 44) $1,348,009; no operation (n = 15) $125,085; length of stay (LOS) of more than ten days (n = 35) $1,124,778; LOS equal to or less than ten days (n = 24) $348,316; nonsurvivors plus LOS equal to or less than ten days plus operation (n = 12) $269,778, and survivor plus LOS greater than ten days plus operation (n = 29) $1,022,284.

Necrotizing fasciitis: a rare complication of appendicitis.

The mortality of acute appendicitis increases sixfold if perforation occurs. We have reported a case of perforated appendix complicated by necrotizing fasciitis of the abdominal wall and retroperitoneum. We believe this complication has not been previously described in the English literature.

The role of splenorrhaphy in splenic trauma.

Eighty-five cases of splenic trauma that were treated surgically from 1981 to 1983 were reviewed to define the exact role of splenorrhaphy. There were 73 male and 12 female patients with a mean age of 34 years. The mechanism of injury was blunt trauma in 51 and penetrating trauma in 34.

Diagnostic peritoneal lavage in the management of blunt abdominal trauma: a reassessment.

In order to reassess the value of diagnostic peritoneal lavage (DPL) in patients with blunt abdominal trauma, we conducted a prospective study over a 15-month period involving 138 patients. There were 29 (28.3%) patients with positive DPL and 103 (71.

Diagnosis-related groups and the salvagable trauma patient in the intensive care unit.

We reviewed 59 patients with trauma treated in the surgical intensive care unit (SICU) in 1983 comparing hospital charges with payments calculated from diagnosis-related groups (DRG). There were 37 male and 22 female patients with a mean age of 38.3 years.

Suspected vascular trauma of the extremities: the role of arteriography in proximity injuries.

We reviewed 72 patients with penetrating trauma to the extremities who underwent arteriography for proximity injury only. None of the patients had clinical evidence of vascular trauma. There were 62 males and ten females, with a mean age of 29.

A prospective randomized study of moxalactam versus gentamicin and clindamycin in penetrating abdominal trauma.

We conducted a randomized, prospective study of moxalactam versus gentamicin plus clindamycin in 42 patients with penetrating abdominal trauma. Patients were randomized to receive intravenously either 2 grams of moxalactam every 12 hours or 80 milligrams of gentamicin every eight hours and 600 milligrams of clindamycin every six hours. Antibiotics were administered preoperatively and continued for a minimum of five days if hollow viscus injury occurred.

Preventable trauma deaths: Dade County, Florida.

We reviewed 1,201 trauma deaths that occurred in Dade County, Florida, in 1982 in order to evaluate the need for an organized trauma network. There were 715 deaths (59.5%) at the scene.

Typhoid perforation of the intestine.

We reviewed 91 cases of intestinal perforation complicating typhoid fever treated at a rural hospital in Haiti over a ten-year period. Surgical management involved simple primary closure of the perforation (80 patients), small-bowel resection with anastomosis (two patients), simple drainage of the peritoneal cavity (two patients), and serosal patching of the perforation (one patient). Six patients died before surgery.

Air entrapment as a cause of transient cardiac pacemaker malfunction.

Air within a pacemaker pocket may cause transient malfunction of a replacement unipolar cardiac pacemaker. This was noted in a patient in whom entrapped air prevented tissue contact of the anode, resulting in complete cessation of myocardial stimulation and absence of an electrocardiographic pacemaker artifact. Methods for avoiding this complication are proposed.