Optimization of meat level and processing conditions for development of chicken meat noodles using response surface methodology.

Response surface methodology (RSM) is a mathematical and statistical technique for testing multiple process variables and their interactive, linear and quadratic effects, and useful in solving multivariable equations obtained from experiments simultaneously. In present study optimum meat level and processing conditions for development of shelf stable chicken meat noodles was determined using central composite design of response surface methodology (RSM). Effects of meat level (110-130 g); processing conditions such as steaming time (12-18 min) and drying time (7-9 h) on the water activity, yield, water absorption index, water solubility index, hardness, overall acceptability and total colour change of chicken noodles were investigated. The aim of present study was to optimize meat level and processing conditions for development of chicken noodles. The coefficients of determination, R(2) of all the response variables were higher than 0.8. Based on the response surface and superimposed plots, the optimum conditions such as 60 % meat level, 12 min steaming time and 9 h drying time for development of chicken noodles with desired sensory quality was obtained.

Spent bullets and their injuries: the result of firing weapons into the sky.

People often celebrate holidays by firing guns into the air without realizing that this can cause serious injury or death. The present study identified 118 patients treated since 1985 who were hit with spent bullets. Most (77%) were hit in the head. The mortality rate was 32%, which is significantly higher than for all gunshot wound victims in general seen at the same medical center. Laws have been enacted to help prevent people shooting into the sky, but more education and enforcement are required to prevent these serious and preventable injuries.

Asymptomatic stab wounds of the chest.

In a prospective study of 4,106 consecutive cases of initially asymptomatic stab wounds of the chest, 88% were successfully treated as outpatients after negative findings on a repeat chest x-ray film 6 hours after presentation, 12% of patients required tube thoracostomy for delayed pneumothoraces of hemothoraces, 0.2% required thoracotomy for delayed and continued bleeding or cardiac injuries, 1% of patients with small pneumothoraces (subjectively less than 20%) were observed, and 68% patients remained asymptomatic. The accuracy of the initial chest x-ray film was 95% overall, with a specificity of 99.9%. The negative predictive value of only 87.4% precludes the immediate outpatient management of these asymptomatic patients. The overall mortality was 0.1%, mortality during or following surgery was 50%. Of the four patients with initially unsuspected cardiac injuries, two patients died in the operating room. Asymptomatic patients (with normal findings on chest x-ray films) may be discharged after 8 hours of observation. Asymptomatic patients with nonprogressive small pneumothoraces (less than 20%) not requiring a chest tube may be discharged after 48 hours of observation. Thirty-two percent of those observed for initially small pneumothoraces on chest x-ray films, had progression of their injuries and required tube thoracostomy. All patients should have close outpatient follow-up.

Extremity gunshot wounds: Part one--Identification and treatment of patients at high risk of vascular injury.

Cost containment is important in this time of inner-city economic and health-care crisis. This paper examines patients who were treated for gunshot wounds (GSWs) of the extremities. During the study period 1978 through 1992, 16,316 patients (18,349 extremities) were treated for extremity GSWs. Nine patients with asymptomatic injuries in proximity to vascular structures who were treated before the use of duplex Doppler ultrasonography (DDU) were later found to have surgically treatable vascular injuries. These were identified and treated on an outpatient basis with no long-term morbidity or mortality. With the advent of DDU, asymptomatic vascular injuries were no longer missed. A conservative estimate of the cost savings from this study is more than $47,000,000.00. The use of DDU and the enclosed protocols for treating asymptomatic extremity wounds prevented 16,450 needless angiograms, with an additional savings of $32,900,000.00, for a total savings of more than $79,900,000.00. With a more liberal use of DDU and angiography to eliminate the rare missed vascular injuries (0.09%), and the use of protocols to analyze patients with asymptomatic injuries, many extremity GSW victims (79% in this study) can be safely treated as outpatients, eliminating the need for expensive in-hospital observation.

Civilian gunshot wounds--outpatient management.

Cost containment is important in this time of inner-city economic and health-care crisis. Of 28,150 patients treated for gunshot wounds (GSWs) from 1977 through 1991, 16,892 (60%) were treated as outpatients after emergency department evaluation and treatment. The complication rate was 1.8% (mostly infections), and nine patients were later found to have vascular injuries requiring surgical treatment. These were identified later at outpatient follow-up and treated with no long-term morbidity or mortality. A conservative estimate of the cost savings from this study was more than $37 million. With a more liberal use of angiography to eliminate rare missed vascular injuries, many GSW victims can be safely treated as outpatients, eliminating the need for expensive in-hospital observation.

Incidence of gunshot wounds at a county hospital following the Los Angeles riot and a gang truce.

An analysis of the number of gunshot wound victims seen at a Los Angeles County Hospital both before and after the Los Angeles riot of 1992 was undertaken. Since the riot, the gang truce between the "Bloods" and the "Crips" has resulted in a significant decrease in the number of gunshot wound victims seen at a level I trauma center in Los Angeles.

Infection in minor gunshot wounds.

Of the 3684 patients enrolled in our study, 3390 were available for follow-up, of which 62 patients developed wound infections related to minor gunshot wounds (1.8%). Of these patients, all sustained entry/exit-type wounds while 60% of these patients sustained more than one injury. Complications were more likely to occur when a prolonged period occurred between the time of injury and the initial treatment. The development of infection in minor gunshot wound injuries is an unusual occurrence when these injuries are limited to the soft tissue structures. Additionally, wound debridement and antibiotics are often unnecessary in minor uncomplicated gunshot wounds, but may be beneficial in patients who have sustained multiple injuries, gross wound contamination, significant tissue devitalization, large wounds, or delay in treatment.

Serum digoxin levels and mortality in 5,100 patients.

A retrospective study of 5,100 patients on digoxin, with a four-week follow up after digoxin levels were measured, was done to determine the mortality rate. A significant increase in mortality was correlated with an increasing serum digoxin level, up to 50% at a level of 6.0 ng/mL and more. Clinical toxicity was suspected in only 0.25% of all patients on digoxin, although almost 10% had levels above the therapeutic range. Deliberate digoxin overdoses were fatal in 50% of cases. This study shows a correlation between increasing digoxin levels and increasing mortality rates. We recommend the use of serum digoxin measurements to identify those asymptomatic patients with elevated levels. The physician should seriously consider the indications for initiating or continuing digoxin treatment in any patient because of an increased mortality in patients with levels of more than 1.0 ng/mL.

Electronic gun (Taser) injuries.

The Taser is an electrical weapon used for immobilization. Two hundred eighteen patients who were shot by police with a Taser for violent or criminal behavior were compared to 22 similar patients shot by police with .38 Specials. The long-term morbidity rate was significantly different for "tasered" victims (0%) and for those with bullet wounds (50%) (P less than .05). The mortality rate was also significantly different between "tasered" victims (1.4%), and gunshot wound victims (50%) (P less than .05). Possible complications associated with Taser wounds included contusions, abrasions, and lacerations (38%); mild rhabdomyolysis (1%); and testicular torsion (0.5%). Although 48% of "tasered" patients required hospitalization, all but one was for a preexisting injury or toxic or psychiatric problem. We conclude that Tasers are relatively safe when compared to shooting with more conventional weapons.

Coagulation abnormalities in traumatic shock.

Coagulation abnormalities can pose a threat to hemorrhaging patients and to attempts at surgical correction. We have shown that 97.2% of our 180 patients who died of trauma had evidence of coagulation defects prior to fluid or blood treatment. Twelve of 180 patients could not be cross-matched due to inability of their blood to coagulate in the tube. Clinically 50% of these patients had excessive oozing from venipuncture sites, and 28% had excessive hematoma formation not associated with vascular injury. The most frequently abnormal test was the prothrombin time, in 97% of patients followed by platelet count in 72%, and partial thromboplastin time in 70%. The greatest degree of coagulation abnormality occurred in patients with head trauma, followed in decreasing order by gunshot wounds, blunt trauma, and stab wounds to the body. Because 97.2% of the patients had abnormal coagulation studies prior to fluid and blood replacement, this abnormality most likely was due to disseminated intravascular coagulation. We propose using the tube-clot test to give a rapid indication of coagulation in traumatized patients while awaiting laboratory test results.

Rat bites: fifty cases.

A prospective study of 50 patients with uninfected rat bite wounds was undertaken to determine the natural incidence of wound infection without prophylactic antibiotics. All open wounds were cultured; bacterial isolates were cultured from 30% of wounds. Of bacterial isolates, 43% were Staphylococcus epidermidis and the remainder were Bacillus subtillus, diphtheroids, and alpha hemolytic Streptococcus. Only one patient (2%) developed an infection. Seventy-two percent of the bites occurred while the patient was sleeping, probably accounting for the fact that 84% of the wounds were on the exposed areas of the upper extremities and face. Treatment recommendations include good surgical management and avoidance of prophylactic antibiotics due to a low natural infection rate. If the wounds become infected, then a cephalosporin or penicillinase-resistant penicillin should be sufficient for treatment with appropriate surgical care of the wounds. Rabies prophylaxis usually is not required, but we suggest that tetanus prophylaxis is mandatory because most of our patients were deficient in this regard.

Wound ballistics: theory and practice.

Ballistics is the study of the natural laws governing projectile missiles and their predictable performances, and wound ballistics is the study of a missile's effect on living tissue. A knowledge of these topics is essential to determine the extent and type of injury from a missile. The type of missile can often be determined by radiography. The caliber can be measured directly if the bullet is close to the x-ray plate and the x-ray tube is at least six feet from the film. Changing these distances can result in a maximum magnification of the bullet image of 20%, and the exact amount can be calculated using a formula provided. Definitions of ballistic and wound ballistic terms are provided, as are examples of wound ballistics in application.

Outpatient management of 357 gunshot wounds to the chest.

There is, at present, little literature to guide one in the management of a patient with a gunshot wound to the chest with normal vital signs, physical examination, and as a normal chest X-ray. The present study followed up 357 patients as outpatients at 48 hours, then 1 and 3 months. No major complications developed. Minor complications included chronic wound pain, chronic wound swelling, and the uncomfortable sensation of being able to palpate one's own subcutaneous bullet. The wound infection rate was only 1.5% with or without antibiotics, showing that prophylactic antibiotics are probably not warranted if good surgical wound care is practised. We conclude that patients with gunshot wounds to the chest with normal vital signs, physical examinations, and normal X-rays can be reasonably treated as outpatients after 4 hours of observation, at the physician's discretion.