Complications arising from splenic embolization after blunt splenic trauma.

Background: Nonoperative management (NOM) of splenic trauma is now the standard in stable trauma patients. Splenic artery embolization (SAE) is an increasingly used adjunct to NOM. We examined complications arising from SAE.

Tetrasulfur, S4: rotational spectrum, interchange tunneling, and geometrical structure.

The rotational spectrum of S4 has been observed for the first time in an electrical discharge through sulfur vapor. Two techniques have been used: Fourier transform microwave spectroscopy and long-path millimeter-wave absorption spectroscopy. Small, but systematic shifts of the measured transition frequencies of the normal isotopic species indicate that S4 has C2v symmetry but with a low-lying transition state of D2h symmetry, yielding interchange tunneling at 14.

The rotational spectrum and geometrical structure of thiozone, S3.

The rotational spectrum of thiozone, S3, has been observed for the first time. From the rotational constants of the normal and 34S isotopic species, a precise geometrical structure has been derived: S3 is a bent chain with a bond to the apex S of length 1.917(1) A and an apex angle of 117.

Ectopic parathyroid adenoma localised with sestamibi SPECT and image-fused computed tomography.

Confident localisation of ectopic parathyroid adenomas, particularly those outside the neck, can be difficult. Even preoperative radiological imaging may not be helpful, as there are few characteristic findings. We report a case in which hyperfunctioning ectopic parathyroid tissue in the mediastinum was detected with technetium-99m-sestamibi single-photon emission computed tomography and accurately localised non-invasively with image-fused computed tomography.

Percutaneous transhepatic pancreatic islet cell transplantation in type 1 diabetes mellitus: radiologic aspects.

Purpose: To report our experience with percutaneous transhepatic pancreatic islet cell transplantation in patients with type 1 diabetes mellitus.

Materials And Methods: Between March 1999 and May 2002, 34 patients underwent 68 islet cell transplantation procedures. Patients with C-peptide-negative type 1 diabetes were selected on the basis of poor metabolic control (hypoglycemia or lability) despite compliance with optimal medical therapy.

Extreme deuterium enrichment in stratospheric hydrogen and the global atmospheric budget of H2.

Molecular hydrogen (H2) is the second most abundant trace gas in the atmosphere after methane (CH4). In the troposphere, the D/H ratio of H2 is enriched by 120 per thousand relative to the world's oceans. This cannot be explained by the sources of H2 for which the D/H ratio has been measured to date (for example, fossil fuels and biomass burning).

Rotational spectrum and structure of Si3.

The rotational spectrum of a pure silicon cluster, the Si3 trimer, has been observed for the first time. From the rotational constants of the normal and the 29Si and 30Si isotopic species, a precise geometrical structure has been derived: the trimer is an isosceles triangle with a bond to the apex Si of length 2.177(1) A and an apex angle of 78.

Detecting acute confusion in older adults: Comparing clinical reasoning of nurses working in acute, long-term, and community health care environments.

In an article on a previous study involving hospitalized older adults (McCarthy, 2003), it was argued that the theory of situated clinical reasoning explains why nurses often fail to recognize acute confusion. Further, the theory illuminates how nurses' perspectives toward health in aging affect the ways they regard and ultimately deal with older people in this particular clinical situation. The purpose of the current study was to challenge and refine the theory by exploring the influence of different care environments on clinical reasoning related to acute confusion.

Need for concomitant proximal fibular epiphysiodesis when performing a proximal tibial epiphysiodesis.

The purpose of this study was to determine: 1) if proximal tibial epiphysiodesis (PTE) results in fibular overgrowth if performed without a concomitant proximal fibular epiphysiodesis (PFE); 2) if fibular overgrowth is prevented by concomitant PFE; and 3) the complications associated with PFE. There were 44 patients in the study, 33 who underwent PTE alone (group 1) and 11 who underwent PTE with concomitant PFE (group 2). Fibular overgrowth was measured at the knee and ankle.

Accuracy of cricothyroidotomy performed in canine and human cadaver models during surgical skills training.

Background: Surgical skills training is an integral component of the Advanced Trauma Life Support (ATLS) Course. Teaching techniques are continuously reevaluated and updated. Recognition of recurring technical errors in the performance of cricothyroidotomy in canine models prompted this comparison to the performance of the procedure in human cadavers.

Differential cytokine and antibody responses to adult and larval stages of Onchocerca volvulus consistent with the development of concomitant immunity.

The possibility of concomitant immunity and its potential mechanisms in Onchocerca volvulus infection were examined by analyzing cytokine and antibody responses to infective larval (third-stage larvae [L3] and molting L3 [mL3]), adult female worm (F-OvAg), and skin microfilaria (Smf) antigens in infected individuals in a region of hyperendemicity in Cameroon as a function of age. Peripheral blood mononuclear cell interleukin 5 (IL-5) responses to F-OvAg and Smf declined significantly with age (equivalent to years of exposure to O. volvulus).

Facial fractures in a level I trauma centre: the importance of protective devices and alcohol abuse.

Urban trauma centres have recently noted a shift in the causative mechanism of facial fractures away from motor vehicle crashes (MVC) to blunt assaults (BA). This study was conducted to examine the incidence and aetiology of facial fractures at our institution as well as the relationship with alcohol and protective device use. Trauma registry records of all patients admitted to a level I trauma centre from 1 January 1988 to 1 January 1999 were reviewed.

Carbon chains and rings in the laboratory and in space.

Seventy-seven reactive organic molecules of astrophysical interest have been identified in a supersonic molecular beam, 73 in the radio band by Fourier-transform microwave spectroscopy, four in the optical by laser cavity ringdown spectroscopy. Most are linear carbon chains, but six consist of carbon chains attached to the compact, highly polar C3 ring, and two are rhomboidal cyclic configurations of SiC3. The laboratory astrophysics of the radio molecules is complete for the time being, in the sense that essentially all the rotational transitions of current interest to radio astronomy (including hyperfine structure when present) can now be calculated to a small fraction of 1 km s(-1) in equivalent radial velocity; six of the radio molecules have already been detected in space on the basis of the present data.

Experimental Structures of the Carbon Chains HC(7)N, HC(9)N, and HC(11)N by Isotopic Substitution.

The effective structures (r(0)) of the three linear cyanopolyynes HC(7)N, HC(9)N, and HC(11)N have been determined to high accuracy by isotopic substitution, following detection in a supersonic molecular beam with a Fourier transform microwave spectrometer of all of the singly substituted rare isotopic species. For each chain, the lengths of the individual bonds have been determined to an accuracy of 0.001 Å or 0.

The Radio Spectra of SiCCH, SiCN, and SiNC.

Three new silicon-bearing radicals of astrophysical interest, SiCCH and the two nearly isoenergetic isomers SiCN and SiNC, were detected in a laboratory discharge in their X2Pi ground states by Fourier transform microwave and millimeter-wave absorption spectroscopy. Hyperfine structure was observed in the low rotational transitions of the (2)Pi(1/2) ladder, and well-resolved Lambda-doubling was observed in both fine-structure ladders. With the spectroscopic constants derived from the laboratory measurements, the spectra of all three can be calculated to an uncertainty of less than 0.

Immunity to onchocerciasis: cells from putatively immune individuals produce enhanced levels of interleukin-5, gamma interferon, and granulocyte-macrophage colony-stimulating factor in response to Onchocerca volvulus larval and male worm antigens.

Antigen-specific interleukin-5 (IL-5), gamma interferon (IFN-gamma), and granulocyte-macrophage colony-stimulating factor (GM-CSF) responses in individuals living in an area of hyperendemicity for onchocerciasis in Cameroon were examined. The responses against antigens prepared from Onchocerca volvulus third-stage larvae (L3), molting L3 (mL3), and crude extract from adult males (M-OvAg) were compared to the responses against antigens from adult female worms and skin microfilariae. Cytokine responses for the putatively immune individuals (PI) and the infected individuals (INF) were compared.

Laboratory Detection of a Molecular Band at lambda4429.

A fairly strong molecular absorption band at 4429.27+/-0.04 Å, closely centered on the strongest diffuse interstellar band at 4428.

Analysis and Deperturbation of the A(2)Pi and B(2)Sigma(+) States of CaF.

A laser excitation spectrum of the (0, 0) and (1, 1) bands of the CaF A(2)Pi-X(2)Sigma(+) system was recorded. The present set of molecular constants for both A(2)Pi and B(2)Sigma(&plus:) states represents a vast improvement in precision over previously reported values because of the larger number of line position measurements and the use of a more reasonable effective Hamiltonian model which accounts explicitly for the A approximately B interaction via off-diagonal matrix elements. The principal constants (in cm(-1)) are where uncertainties of 1varsigma are given in parentheses.

Electronic Ground and Excited State Spectroscopy of C(6)H and C(6)D.

Rotational transitions in the X(2)Pi ground state of C(6)H and C(6)D have been measured by Fourier transform microwave and millimeter-wave absorption spectroscopy. More than 150 rotational lines in the ground (2)Pi(3/2) and (2)Pi(1/2) ladders have been observed, allowing an accurate determination of the rotational, fine structure, lambda-doubling, and hyperfine coupling constants using a standard effective Hamiltonian for a molecule in an isolated (2)Pi electronic state. The molecular ground state constants are used to characterize the rotationally resolved origin band of the (2)Pi <-- X(2)Pi electronic transition observed by cavity ring-down laser absorption spectroscopy in a pulsed supersonic slit-jet discharge source.

Microwave Spectra of the Methylpolyynes CH(3)(C&tbond;C)(6)H and CH(3)(C&tbond;C)(7)H.

Two new methylpolyynes, CH(3)(C&tbond;C)(6)H (tridecahexayne) and CH(3)(C&tbond;C)(7)H (pentadecaheptayne), have been detected in a supersonic molecular beam by Fourier transform microwave spectroscopy. A total of 20 transitions of CH(3)(C&tbond;C)(6)H in the K = 0 and 1 rotational ladders and 8 transitions of CH(3)(C&tbond;C)(7)H in the K = 0 ladder were observed between 5 and 11 GHz, allowing for both molecules precise determination of rotational and centrifugal distortion constants. Like other long carbon chains of similar length, the rotational constants of the two new methylpolyynes are well predicted by extrapolation from the shorter members of the sequence; the addition of successive C(2) units evidently little perturbs the structure of the rest of the molecule.

Pressure control inverse ratio ventilation in the treatment of adult respiratory distress syndrome in patients with blunt chest trauma.

The objective of this study was to evaluate the efficacy of pressure control inverse ratio ventilation (PCIRV) in improving oxygenation in trauma patients with adult respiratory distress syndrome (ARDS) and to assess the potential risks associated with this form of treatment. This was a cohort study assessing the trends in hemodynamic and ventilatory parameters after the initiation of PCIRV, conducted at a community Level I trauma center intensive care unit. The study comprised 15 trauma patients developing severe, progressive ARDS [two or more of the following criteria: positive end-expiratory pressure (PEEP) >10 cm H2O; arterial partial pressure of oxygen divided by fraction of inspired oxygen (PaO2:FiO2) ratio <150; and peak inspiratory pressure (PIP) >45 cm H2O]: ten due to blunt chest injuries, three due to sepsis, and two due to fat emboli syndrome.

Traditional criteria for observation of splenic trauma should be challenged.

Age less than 55 years, normal Glasgow Coma Score (GCS), and absence of hypotension are traditional criteria for the selection of adult patients with blunt splenic trauma for observation. The objective of this study is to challenge these criteria. Two hundred twelve patients who presented with blunt splenic injury between 1992 and 1997 were identified from the Trauma Registry at our Level I trauma center.

Children's and parents' visual perception of physicians.

The purpose of this study is to evaluate the child's and parents' visual perception of physicians. To do this, 50 children and their parents were asked which physician they preferred, when shown eight pairs of photographs. Four characteristics were tested twice, white coat versus no white coat, smile versus stern face, cartoon posters versus no posters, and standing versus stooping.

APACHE II and ISS scores as predictors of nosocomial infections in trauma patients.

Background: Nosocomial infections affect more than 2 million patients annually in the United States at a cost of $4.5 billion. The aim of this study is to identify the role of the APACHE II score and the Injury Severity Scale (ISS) as independent predictors of nosocomial infections in trauma patients admitted to the intensive care unit (ICU).