Analysis of radiation exposure in trauma patients at a level I trauma center.

Background: Trauma patients are exposed to potentially high levels of low-dose radiation during radiologic studies.

Objectives: To assess the cumulative effective dose (CED) of radiation exposure (RE) in 177 successive patients admitted to a trauma service from January 1 through February 28, 2006.

Results: Patients received a total of 1505 radiographs and 400 computed tomography (CT) scans in the study period.

Radiation trends in trauma patients.

Today, computed tomography (CT) and other studies are used more often early in a trauma case than X-rays, exposing patients to more radiation. The long-term effects of radiation exposure (RE) in trauma patients are of great concern. Investigators randomly selected 60 patients (injury severity scores 15-25) each from the years 2000, 2003, and 2006.

Randomized trial evidence supporting a strategy of thrombus removal for acute DVT.

Reports of strategies of thrombus removal for acute deep venous thrombosis (DVT), especially in patients with iliofemoral DVT, consistently demonstrate improved outcomes relative to postthrombotic morbidity. Randomized trials support the observation that a strategy of thrombus removal reduces postthrombotic syndrome in patients with extensive proximal DVT. Unfortunately, there have been few randomized trials to date and they do not stand up to rigorous methodological review.

A self-assessment tool for oncology nurses: preliminary implementation and evaluation.

Nurses who fail to identify knowledge gaps in their practice and who do not maintain competence place patients with cancer at risk for adverse events and poor outcomes. Self-assessment tools can assist oncology nurses in identifying knowledge deficits in fundamental oncology concepts. This article describes the development and implementation of a self-assessment tool to assist nurses in maintaining competence to provide safe, effective oncology care.

A randomized, controlled trial of endovenous thermal ablation using the 810-nm wavelength laser and the ClosurePLUS radiofrequency ablation methods for superficial venous insufficiency of the great saphenous vein.

Background: Great saphenous vein (GSV) incompetence is the most common cause of superficial venous insufficiency. Radiofrequency catheter ablation (RFA) is superior to conventional ligation and stripping, and endovenous laser treatment (EVL) has emerged as an effective alternative to RFA. This randomized study evaluated RFA and EVL for superficial venous insufficiency due to GSV incompetence and compared early and 1-year results.

Endovenectomy of the common femoral vein and intraoperative iliac vein recanalization for chronic iliofemoral venous occlusion.

Chronic postthrombotic occlusion of the iliofemoral venous segments produces severe morbidity, which can be alleviated if venous drainage is restored. The common femoral vein (CFV) cannot always be fully recanalized with percutaneous endovenous techniques alone. We report the technique combining operative endovenectomy and patch venoplasty of the CFV with intraoperative iliac vein venoplasty and stenting to restore unobstructed venous drainage from the infrainguinal venous system to the vena cava.

Upper extremity ischemia treated with tissue repair cells from adult bone marrow.

Background: Unreconstructable critical ischemia with gangrene of the upper extremity is rarely due to atherosclerosis alone, and few treatment options exist. We describe a patient with gangrene of both hands as a result of unreconstructable atherosclerotic disease of both upper extremities who was successfully treated with tissue repair cells (TRCs) produced from the patient's bone marrow.

Methods: A patient with type 1 diabetes was referred with bilateral upper extremity digital gangrene due to unreconstructable forearm and hand atherosclerosis.

Bilateral nonthrombotic subclavian vein obstruction causing upper extremity venous claudication.

Venous complications of thoracic outlet obstruction are frequently the result of acute axillosubclavian vein thrombosis, leading to symptoms consistent with venous claudication, including pain, swelling, and cyanotic discoloration. Nonthrombotic subclavian vein obstruction, however, is an uncommon cause of veno-occlusive symptoms. We report the case of a patient who, while running, developed pain consistent with venous claudication in her left arm and subsequently in her right arm.

The ATTRACT trial: rationale for early intervention for iliofemoral DVT.

The management of acute deep vein thrombosis (DVT) by medical therapy with anticoagulation has long been supported by evidence-based clinical practice guidelines outlined in the American College of Chest Physicians supplement. Early thrombus removal in patients with iliofemoral DVT has been reported to lead to improved venous valve function, improved quality of life, and decreased incidence of postthrombotic syndrome over anticoagulation alone. The ATTRACT trial will randomize patients to medical management with standard anticoagulation versus catheter-directed thrombolysis in addition to standard anticoagulation after stratification to iliofemoral versus femoropopliteal DVT in order to determine the primary outcome of postthrombotic syndrome over a 24-month follow-up.

Clinical implications of the seat belt sign in blunt trauma.

Patients with the seat belt sign (SBS) from motor vehicle crashes (MVCs) are prone to specific regional injury patterns. Investigators at a Level 1 trauma center analyzed the incidence, clinical implications, and spectrum of regional injuries in patients injured in MVC over 2 years. SBS was seen in 11.

Automated assays for sVEGF R1 and PlGF as an aid in the diagnosis of preterm preeclampsia: a prospective clinical study.

Objective: The purpose of this study was to assess the utility of soluble vascular endothelial growth factor 1 (sVEGF R1) and placental growth factor (PlGF) levels in the clinical diagnosis of preeclampsia.

Study Design: Plasma was collected prospectively from 457 subjects (n = 409 without preeclampsia, n = 48 with preeclampsia) at 20-36 weeks' gestation. Automated immunoassays were used to measure free sVEGF R1 and free PlGF.

Upgrading the American Association of Critical-Care Nurses' evidence-leveling hierarchy.

In August 2008, the American Association of Critical-Care Nurses' (AACN's) Evidence-Based Practice Resource Work Group met to review current AACN Practice Alerts and to identify new Practice Alerts to be created. The work group was also tasked with reassessment of the grading system used by AACN that evaluates evidence associated with the Practice Alerts and other AACN resources. This article details the effort of this national volunteer work group, specifically highlighting the development of the new AACN evidence-leveling hierarchy system.

Urinothorax: a rare complication of total abdominal hysterectomy.

Background: Urinothorax is defined as the presence of urine in the pleural cavity. This condition is due to the leakage of urine from the peritoneal and retroperitoneal space into the pleural space. We report a case of urinothorax after total abdominal hysterectomy.

Heparin-induced thrombocytopenia after implantation of a heparin-bonded polytetrafluoroethylene lower extremity bypass graft: A case report and plan for management.

The proprietary heparin-bonded expanded polytetrafluoroethylene graft appears to be an attractive option for lower extremity revascularization in patients with compromised runoff and no autogenous vein. There is no detectable elution of heparin from the graft surface, but antithrombotic activity has been detected in devices implanted for >2 years. Although 15,000 Propaten (W.

Can intraoperative thrombolytic therapy assist with the management of acute limb ischemia?

Catheter-directed thrombolytic therapy is a well-accepted treatment modality for acute arterial and graft occlusion, but intraoperative use of plasminogen activators as an adjunct to operative thrombectomy or thromboembolectomy is frequently overlooked by vascular surgeons. Evidence exists that intraoperative intraarterial infusion of lytic agents is safe and is accompanied by breakdown of distal thrombus. This article describes the rationale for intraoperative thrombolysis, reviews the evidence supporting its use, and suggests several technical approaches to incorporating lytic therapy intraoperatively.

The quantitative benefit of isolated, segmental, pharmacomechanical thrombolysis (ISPMT) for iliofemoral venous thrombosis.

Background: Early thrombus removal in patients with iliofemoral deep venous thrombosis (IFDVT) reduces postthrombotic morbidity. Preserving valve function and relieving venous obstruction prevents deterioration of quality of life and loss of economic potential. The preferred method for treating IFDVT is catheter-directed thrombolysis (CDT).

Hyperemic maximal venous outflow unmasks symptomatic lower extremity venous obstruction.

Venous obstruction is an underappreciated and often unrecognized component of the pathophysiology of symptomatic chronic venous disease (CVD). Moreover, standard methods used to detect venous obstruction, such as maximal venous outflow, are inadequate as they typically test patients at rest and in the supine position when the pathophysiology of CVD is defined in the upright patient performing exercise. This report describes a patient with incapacitating venous claudication in whom standard noninvasive venous function tests were normal and whose phlebography was interpreted as showing no evidence of venous obstruction.

Pelvic fracture risk assessment on admission.

Patients with pelvic fractures (PF) have high incidences of associated injuries and mortality. To identify patients with PF at the highest risk for mortality on admission to a Level I trauma center, investigators analyzed 566 PF in 12,128 patients (1996 to 2005). PF were categorized on arrival as high risk (HR) or low risk (LR) by initial blood pressure, examination, radiographs, and CT.

Use of the abdominal aorta as an alternative access site for thoracic aortic stent graft placement.

The treatment of thoracic aortic pathology has undergone a paradigm shift in recent years, with a trend toward less invasive endovascular techniques and away from open surgical repair. Reports on the successful use of endografts in the thoracic aorta have demonstrated decreased morbidity and mortality of these procedures compared with traditional open repair. However, some patients are not candidates for an endovascular approach because of a short proximal landing zone, arch angulation, luminal irregularities, or a large diameter of the transverse arch and the proximal descending aorta.