Prevalence of sparganosis by county of origin in Florida feral swine.

Sparganosis is a parasitic infection in amphibians, reptiles and mammals including feral swine and man. It is caused by migration of the metacestode (spargana) of Spirometra. The primary objective of this study was the determination of the prevalence of gross sparganosis in Florida county of origin in slaughtered feral swine.

A strangulated Spigelian hernia mimicking diverticulitis.

Spigelian hernias are true interparietal hernias that are frequently not associated with a palpable mass and, as such, are not frequently diagnosed before surgery. Reported herein, is the serendipitous discovery of an incarcerated Spigelian hernia that was discovered on a CT scan being performed for presumed diverticulitis.

Chest radiographs of limited utility in the diagnosis of blunt traumatic aortic laceration.

Background: The radiographic diagnosis of blunt traumatic aortic laceration (BTAL) remains problematic. We reviewed our experience with chest radiographic signs of BTAL at a single trauma center.

Methods: The chest radiographs of 188 consecutive blunt trauma patients with suspected BTAL who underwent portable chest radiography and aortography were retrospectively reviewed by a thoracic radiologist.

A population-based study of geriatric trauma in a rural state.

Background: Urban geriatric trauma patients are known to die more often than their younger counterparts. Little is known of the fate of geriatric trauma patients in a rural environment where delays to definitive treatment are frequent. We hypothesized that rural trauma patients would do worse than their urban counterparts because of prolonged delays to definitive care.

Population-based study of hospital trauma care in a rural state without a formal trauma system.

Objective: Formalized systems of trauma care are believed to improve outcomes in an urban setting, but little is known of the applicability in a rural setting.

Methods: We conducted a population-based analysis of hospital survival after trauma comparing an American College of Surgeons-verified Level I trauma center (TC) with the pooled results of 13 small community hospitals (CH) in a rural state with no formal trauma system. All patients admitted to any hospital within the state of Vermont over a 5-year period (1995-1999) with a trauma discharge diagnosis were included.

Do pediatric trauma centers have better survival rates than adult trauma centers? An examination of the National Pediatric Trauma Registry.

Background: Pediatric trauma centers (PTCs) were developed to improve the survival of injured children, but it is currently unknown if children admitted to PTCs are more likely to survive than those admitted to adult trauma centers (ATCs).

Methods: Fifty-three thousand one hundred thirteen pediatric trauma cases from 22 PTCs and 31 ATCs included in the National Pediatric Trauma Registry were reviewed to evaluate survival rates at PTCs and ATCs.

Results: Overall, 1,259 children died.

The clinical spectrum of acute coronary syndromes.

More than 5 million Americans visit hospital emergency departments each year with the complaint of chest pain. Two million patients are admitted to hospitals because of chest pain, but the diagnosis of coronary heart disease is confirmed in only one fourth of them. Acute coronary syndrome represents a clinical syndrome that includes unstable angina, non-Q-wave myocardial infarction and Q-wave myocardial infarction.

Impaired culprit vessel flow in acute coronary syndromes ineligible for thrombolysis.

The majority of patients with acute myocardial infarction and other acute coronary syndromes (ACS) are considered ineligible for thrombolysis and do not routinely receive reperfusion therapy. We hypothesized that predictors and outcomes of angiographically impaired culprit vessel flow can be identified and compared. This trial evaluated the outcomes following triage angiography in acute coronary syndromes ineligible for thrombolytic therapy.

Nonoperative management of hepatic, splenic, and renal injuries in adults with multiple injuries.

Background: Nonoperative management (NOM) of abdominal solid organ (ASO; liver, spleen, kidney) injuries from blunt trauma in adults has gained acceptance, but multisystem trauma remains a relative contraindication to NOM.

Methods: We reviewed the charts of 126 adult patients who underwent NOM of an ASO injury for success of NOM, transfusions, and complications. Patients were divided into two groups: group I had isolated ASO injuries (n = 48); group II had an ASO injury and at least one additional injury with an Abbreviated Injury Score > or = 2 (n = 78).

Prostaglandin F(2alpha) (PGF(2alpha)) induces cyclin D1 expression and DNA synthesis via early signaling mechanisms in Swiss mouse 3T3 cells.

Prostaglandin F(2alpha) (PGF(2alpha)), a mitogen for Swiss 3T3 cells, triggers cyclin D1 mRNA/protein expression prior to cellular entry into the S phase, but fails to raise cdk4 or cyclin D3 levels, while 1-oleoyl-2-diacylglycerol (OAG), a protein kinase C (PKC) and tyrosine kinase (TK) activator, induces only cyclin D1 expression with no mitogenic response. In contrast, in PKC-depleted or -inhibited cells, PGF(2alpha), but not OAG, increases cyclin D1 expression with no mitogenic response. Finally, OAG, in the presence of orthovanadate (Na(3)VO(4)) or TGF(beta1), induces DNA synthesis.

A multi-institutional study of factors associated with fetal death in injured pregnant patients.

Hypothesis: Factors associated with fetal death in injured pregnant patients are related to increasing injury severity and abnormal maternal physiologic profile.

Design: A multi-institutional retrospective study of 13 level I and level II trauma centers from 1992 to 1996.

Main Outcome Measure: Fetal survival.

Rural trauma: the challenge for the next decade.

Improving the care of trauma patients in a rural environment requires that several important issues be addressed. First, a universal definition of what constitutes "rural" must be established. We propose that a combined effort of the Federal Government and the Committee on Trauma of the American College of Surgeons develop this definition.

Effects of exercise training on chronotropic incompetence in patients with heart failure.

Objective: To describe the effects of exercise training on chronotropic incompetence in patients with stable heart failure, as measured by their inability to achieve a peak exercise heart rate greater than 85% of maximum.

Background: Exercise intolerance and chronotropic incompetence are characteristic of patients with heart failure. Exercise training improves exercise capacity in these patients; however, to what extent reversal of chronotropic incompetence contributes to such a response remains uncertain.

Further determination of DNA relatedness between serogroups and serovars in the family Leptospiraceae with a proposal for Leptospira alexanderi sp. nov. and four new Leptospira genomospecies.

DNA relatedness was determined among 303 strains of Leptospira and Leptonema. Included in the analysis were reference strains from 228 well-characterized and recognized serovars. The study included 268 serovars from 29 named and one or more unnamed serogroups.

Focused abdominal sonogram for trauma: the learning curve of nonradiologist clinicians in detecting hemoperitoneum.

Background: The focused abdominal sonogram for trauma (FAST) has been used by surgeons and emergency physicians (CLIN) to screen reliably for hemoperitoneum after trauma. Despite recommendations for "appropriate training," ranging from 50 to 400 proctored examinations, there are no supporting data.

Methods: We prospectively examined the initial FAST experience of CLIN in detecting hemoperitoneum by using diagnostic peritoneal lavage, computed tomography, and clinical findings as the diagnostic "gold standard.

Financial aspects of providing trauma care at the extremes of life.

Background: Children and the elderly are more likely to be underinsured compared with the general population of trauma patients. We performed financial analysis on all trauma patients admitted during an 18-month period to a Level I adult and pediatric trauma center to evaluate the financial impact of providing trauma care for children and the elderly.

Methods: Patients were categorized by age: PEDI<17 years, GERI>64 years and MID = 17 to 64 years.

Computed tomographic angiography as a screening modality for blunt cervical arterial injuries: preliminary results.

Background: The diagnosis of blunt cervical arterial injury (CAI) is made difficult by its infrequent occurrence and delayed presentation. Beginning in January of 1995, we used computed tomographic angiography (CTA) of the neck to screen for CAI. We hypothesized that CTA could be incorporated into the workup of patients sustaining blunt neck injury as a screening modality for CAI and that CTA would increase the early detection of CAI.

Study of the outcome of patients transferred to a level I hospital after stabilization at an outlying hospital in a rural setting.

Objective: To determine the characteristics and outcome of transferred trauma patients in a rural setting.

Methods: We conducted a case-control study of all trauma admissions to a rural Level I trauma center to examine a 3.5-year (1993-1996) comparison of trauma patients admitted directly with those transferred (RTTP) after being initially stabilized at an outlying hospital.

Tumor-targeted apoptosis by a novel spermine analogue, 1,12-diaziridinyl-4,9-diazadodecane, results in therapeutic efficacy and enhanced radiosensitivity of human prostate cancer.

Interference with polyamine transport and biosynthesis has emerged as an important anticancer strategy involving polyamine analogues and specific inhibitors of key biosynthetic enzymes. Because the prostate gland has a high polyamine content, by using the polyamine transporter for selective uptake into cancer cells, alkylating polyamines are likely to be highly effective against prostatic tumors. We have recently synthesized a novel class of spermine analogues, the lead compound of which has efficacy against human cancer cells (P.

A prospective randomized trial of triage angiography in acute coronary syndromes ineligible for thrombolytic therapy. Results of the medicine versus angiography in thrombolytic exclusion (MATE) trial.

Objectives: The purpose of this study was to determine if early triage angiography with revascularization, if indicated, favorably affects clinical outcomes in patients with suspected acute myocardial infarction who are ineligible for thrombolysis.

Background: The majority of patients with acute myocardial infarction and other acute coronary syndromes are considered ineligible for thrombolysis and therefore are not afforded the opportunity for early reperfusion.

Methods: This multicenter, prospective, randomized trial evaluated in a controlled fashion the outcomes following triage angiography in acute coronary syndromes ineligible for thrombolytic therapy.

Predicting survival, length of stay, and cost in the surgical intensive care unit: APACHE II versus ICISS.

Background: Risk stratification of patients in the intensive care unit (ICU) is an important tool because it permits comparison of patient populations for research and quality control. Unfortunately, currently available scoring systems were developed primarily in medical ICUs and have only mediocre performance in surgical ICUs. Moreover, they are very expensive to purchase and use.