Cofactors of alcohol-related trauma at a rural trauma center.

To analyze the cofactors of alcohol-related trauma at a rural, Level II trauma center, 127 admitted trauma patients were interviewed about psychological problems, social factors, and medical histories. Patients were divided into two groups, blood alcohol content (BAC) positive and BAC negative, for analysis. Seventy-one patients (56%) were BAC negative; 56 (44%) were BAC positive. Forty-three of the 82 males (52%) had positive BAC tests, compared with 13 of the 45 females (29%) (P = .01). Fifty-one of the 56 BAC-positive patients (91%) were aged 21 to 50 years, compared with 29 of the 71 BAC-negative patients (41%) (P = .0001). Ten of the 12 patients (83%) who were recently unemployed were BAC positive, compared with 46 of the 115 patients (40%) who were not recently unemployed (P = .004). Eleven of the 12 patients (92%) with positive drug screens were BAC positive, compared with 45 of the 115 patients (39%) with negative drug screens (P = .0005). These results show that there are important cofactors of alcohol-related trauma in rural areas.

HIV infection among rural trauma patients: a blind serosurvey and literature review.

Human immunodeficiency virus (HIV) seroprevalence rates among rural trauma patients range between 0.15 and 1.32 per cent. A random sample of trauma patients treated at our rural trauma center between September 1994 and November 1995 was enrolled into a blind HIV serosurvey. Five hundred sixty-six of 1315 trauma patients (43%) were tested. Two of the 566 patients (0.35%) were HIV positive. A review of aggregate data for HIV infection among rural trauma patients in the United States show that 28 of the 4639 patients (0.60%) are HIV positive. We conclude that there was a low HIV incidence among our trauma patients from September 1994 to November 1995, and the cost-effectiveness of HIV testing for rural trauma patients is questionable with incidences between 0.5 and 1.0 per cent.

Condyloma acuminata in infants and children. A survey of colon and rectal surgeons.

PURPOSE: Condyloma acuminata are anogenital warts caused by a human papillomavirus. Human papillomavirus is a tissue-specific, site-specific, double-stranded DNA virus, which is capable of inducing high-grade genital intraepithelial neoplasia and malignancy. The incidence of anogenital warts in the pediatric age group is rising, and sexual abuse has been implicated as a potential cause. METHODS: Accumulated data from separate questionnaires sent to practicing colorectal surgeons who are members of The American Society of Colon and Rectal Surgeons and fellows in colon and rectal training programs have been analyzed. RESULTS: Thirty percent of those polled responded to our survey. Of the respondents, 93 percent see less than two pediatric cases per year. Seventy-two percent stated that tissue specimens would be sent routinely for histopathologic identification. Although 73 percent of surgeons consider anogenital warts a potentially sexually transmitted disease, only 26 percent reported screening for other sexually transmitted diseases. A diagnostic and therapeutic protocol is followed by 19 percent of respondents. Patient follow-up varied from six months (43 percent) to lifelong examinations (3 percent). Sixty-four percent of respondents agreed that a diagnostic and therapeutic protocol based on current knowledge would be beneficial. CONCLUSION: We conclude that colon and rectal surgeons have a low exposure to anogenital warts in infants and children. Furthermore, we believe that a diagnostic and therapeutic protocol based on the current literature would be helpful.

Centrifugal pump failures.

Centrifugal pumps will not pass gross quantities of gaseous emboli due to the nonocclusive nature of the pump. However, retrograde flow can occur under circumstances that include: product malfunctions, low flows, and human errors. Negative pressure created by falling arterial perfusate can draw air into the cannula. Food and Drug Administration (FDA) records about centrifugal pump malfunctions were obtained. Out of 350,000 cases completed with centrifugal pumps over a 23 month period, the FDA received reports of 68 malfunctions, 22 electrical burning smells, and three speed surges, yielding a failure rate of 1 in 3,763 cases. FDA records revealed five death reports and three serious injury reports. A survey was sent to 2,424 Society of Thoracic Surgeons' members to obtain more information; 285 who use centrifugal pumps responded. Sixty surgeons (21%) reported 108 malfunctions, including 46 complete pump failures. Fifty-one of 243 surgeons (21%) who use centrifugal pumps for bypass reported that perfusionists have forgotten to clamp the pump line, resulting in backflow. We conclude centrifugal pumps are generally safe, but malfunctions, low flows, and human errors can lead to retrograde flow and occasionally air embolization. There are valves that can be added to the bypass circuitry to prevent this risk.

Experimental thoracoabdominal airgun wounds in a porcine model.

UNLABELLED: The Consumer Product Safety Commission estimates that there are 31,000 airgun injuries annually, 19,000 of which occur in children under 14 years of age. Case reports in the literature include 235 serious and nine lethal pediatric injuries. No experimental model of thoracoabdominal airgun pellet perforation exists. A 60-pound newly killed pig was selected as a model for pediatric airgun injuries. Two commonly available .177-caliber airguns were fired from point blank, 2.5 feet, and 5 feet. A chronograph was used to measure impact velocities for pellets fired at the already-killed pig. Autopsy study of organ wounding was completed. Perforation velocities with point-tip pellets were 407 ft/sec for the thoracic wall and 399 ft/sec for the abdomen. Of the 18 pellets shot at the chest, eight passed through the chest wall, causing 15 organ injuries. Eleven of the 18 pellets perforated the abdominal wall, producing 49 organ injuries. CONCLUSION: Airguns create serious intracavitary organ injuries in a porcine model. Moreover, ballistic research is possible in unusual surroundings, such as a packing plant.

Physician understanding of the National Practitioner Data Bank.

National Practitioner Data Bank (NPDB) reports are part of the process for acquiring staff privileges, professional credentials, and licenses throughout a physician's entire career. We surveyed our hospital's 66 residents to assess their understanding of NPDB. Only 9 residents had heard about NPDB. A follow-up survey of the 10 medical schools in Pennsylvania and Maryland showed just 4 schools covered NPDB in their curricula. Finally, we did a third survey--of 1,410 Pennsylvania Medical Society members. Eighty-one percent did not know that denial of initial license application was not a reportable offense; 69% did not know that voluntary entrance into alcohol/drug rehabilitation was not reportable; and 75% did not know that denial of expanded privileges because of level of clinical competence was reportable. Only 13% knew how to obtain their files. Our surveys suggest physicians have a poor understanding of NPDB even though these reports could have career-jeopardizing implications, especially if the Clinton administration expands access to NPDB.