Risk of hysterectomy and salpingectomy or oophorectomy compared to repair after pelvic gynecologic trauma.

PURPOSE: Pelvic gynecologic trauma (PGT) includes injury to the uterus, ovaries or fallopian tubes. We hypothesized Injury Severity Score (ISS) ≥ 25, hypotension on admission and age ≥ 51 (average age for menopause) would be independent risk factors for resection compared to repair. METHODS: A retrospective analysis of the National Trauma Data Bank was performed between 2007 and 2015. RESULTS: Of 2,040,235 female patients, 1938 (< 0.1%) presented with PGT with the majority sustaining injury to the ovary or fallopian tubes (52.9%). Most patients were managed nonoperatively (77.1 vs 22.9%). On multivariable analysis, in patients with injury to the uterus, ISS ≥ 25 (OR 3.52, CI 1.67-7.48, p < 0.05) was associated with higher risk for hysterectomy compared to repair. In patients with injury to the ovaries or fallopian tubes, gunshot wound (OR 3.73, CI 1.43-9.68, p < 0.05) was associated with a higher risk for salpingectomy or oophorectomy compared to repair. Age ≥ 51 and hypotension on admission were not independent risk factors for resection in patients with PGT. Operative treatment was associated with a lower risk for mortality in patients with an injury to the uterus (OR 0.27, CI 0.14-0.51, p < 0.001) or ovaries/fallopian tubes (OR 0.37, CI 0.19-0.72, p < 0.001) compared to those managed nonoperatively. CONCLUSION: In the largest study reported, PGT occurred in < 0.1% of traumas involving women. Patients with ISS ≥ 25 have higher risk for hysterectomy compared to repair. Gunshot injuries have higher risk for salpingectomy or oophorectomy compared to repair. Hypotension on arrival or age ≥ 51 are not independent risk factors for resection in PGT. Operative management is associated with lower risk of mortality in PGT patients.

Renal toxicity of ethylene glycol results from internalization of calcium oxalate crystals by proximal tubule cells.

Ethylene glycol exposure can lead to the development of renal failure due to the metabolic formation of calcium oxalate monohydrate (COM) crystals. The renal damage is closely linked to the degree of COM accumulation in the kidney and most likely results from a COM-induced injury to proximal tubule (PT) cells. The present studies have measured the binding and internalization of COM by primary cultures of normal PT cells from humans and from Wistar and Fischer-344 rats in order to examine the roles of these uptake processes in the resulting cytotoxicity. Internalization was determined by incubation of cells with [(14)C]-COM at 37 degrees C, removal of bound COM with an EDTA incubation, followed by solubilization of cells, as well as by transmission electron microscopy of COM-exposed cells. COM crystals were internalized by PT cells in time- and concentration-dependent manners. COM crystals were bound to and internalized by rat cells about five times more than by human cells. Binding and internalization values were similar between PT cells from Wistar and Fischer-344 rats, indicating that a differential uptake of COM does not explain the known strain difference in sensitivity to ethylene glycol renal toxicity. Internalization of COM correlated highly with the degree of cell death, which is greater in rat cells than in human cells. Thus, surface binding and internalization of COM by cells play critical roles in cytotoxicity and explain why rat cells are more sensitive to COM crystals. At the same level of COM accumulation after ethylene glycol exposure or hyperoxaluria in vivo, rats would be more susceptible than humans to COM-induced damage.

An outbreak of West Nile virus-associated disease in domestic geese (Anser anser domesticus) upon initial introduction to a geographic region, with evidence of bird to bird transmission.

West Nile virus activity in Manitoba was documented for the first time by the collection of an infected crow found on July 8, 2002, in Winnipeg. West Nile virus was identified as the cause of death for a large number of domestic geese at a single farm in southern Manitoba in August. Of the 5 differently aged cohorts on the affected farm, which included 2 breeding flocks and 3 growing flocks, the 6-week-old cohort was most severely affected with 692 of 2731 goslings dying within a 10-day period. Seroprevalence of West Nile virus in 2 clinically affected and recovered juvenile cohorts was 98% and 100%. In breeding geese without clinical disease, seroprevalence was 90% for 15-month-old birds and 10% for 5-year-old birds. Seroreaction in 3 of 4 cohorts tested exceeded what would be expected by mosquito transmission alone.

Microwave and digital imaging technology reduce turnaround times for diagnostic electron microscopy.

The contributions of microwave methods and digital imaging techniques, when taken together, can reduce routine specimen processing and evaluation for diagnostic electron microscopy to a time frame never thought possible. Significant improvements in both technologies over the last 5 years led the authors to evaluate their combined attributes as the most likely candidate to provide a realistic solution in the reduction of turnaround times for diagnostic electron microscopy. For diagnostic electron microscopy to compete favorably with immunohistochemistry and other ancillary diagnostic techniques, it must improve its turnaround time. To evaluate this hypothesis the microwave-assisted processing results of over 2,000 diagnostic cases were evaluated as was a digital image administration system used for the acquisition and dissemination of diagnostic results. The incorporation of both technologies resulted in turnaround times being reduced to 4 h or less.