Civilian injuries due to unexploded ordnance in military training areas in southern Israel.

BACKGROUND: The problem of unexploded ordnance (UXO) is global and is usually associated with active or former war zones. Civilian injuries due to UXO in military training areas are not common. METHODS: This is a retrospective case series study based on prospectively collected data on patients who sustained injuries from UXO explosions and were admitted to the Soroka University Trauma Center during a five-year period. RESULTS: Twelve patients were included in this series. All patients were Bedouin and the distribution of injuries was concentrated around the head and upper and lower extremities, with sparing of the torso. CONCLUSION: Awareness and implementation of preventive measures are expected to reduce the incidence of this type of injury.

Adenosine in burn blister fluid.

BACKGROUND: Burn wound blister fluid is known to sustain suppressive effects on various components of the immune system. Damaged tissues cause an increase of adenosine concentrations. Since adenosine is a potent anti-inflammatory agent we hypothesized that burn blister fluid contains high concentrations of this nucleoside. METHODS: Burn blister fluid was drawn from eleven patients who suffered a second degree burn injury. Adenosine concentrations were determined using high performance liquid chromatography (HPLC). RESULTS: Elevated adenosine levels were detected in 6 of the 11 patients (54.5%), with an overall mean of 1.13+/-0.52 mM. CONCLUSIONS: This is the first documented data showing increased concentrations of adenosine in burn blister fluid.

Gastric outlet obstruction by gallstone: Bouveret syndrome.

Gallstone has rarely been described as a cause of gastrointestinal obstruction. However, the relative incidence of gallstone ileus increases significantly with age. The gastric outlet is very seldom the location of obstruction by a gallstone. The diagnosis of this condition is not difficult. Nevertheless, if treatment is delayed, high morbidity and mortality rates result. Comprehensive treatment aims to relieve the obstruction, to close the biliodigestive fistula and to prevent further gallbladder complications. The surgeon who deals with this type of illness should tailor the treatment plan according to the age, general condition, and intraoperative findings of the individual patient. This paper presents a case report of an 88-year-old woman with gastric outlet obstruction caused by a gallstone.

[Acute ischemia of the lesser gastric curvature--a rare marker of sclerotic disease].

The rich blood supply of the stomach protects it from ischemia and necrosis. Acute gastric ischemia, an emergency with high mortality, is rare. Atherosclerosis is the leading cause of acute ischemia, and the lesser curvature of the stomach is more vulnerable due to its relatively lesser blood supply. Reduction in gastric blood supply usually presents as chronic disease characterized by gastritis, gastric ulcer, or gastroparesis. Gastroscopy can identify lesions of the gastric mucosa, and angiography demonstrates occluded vessels. Treatment of acute gastric ischemia is surgical, with total gastrectomy preferred over partial resection.

[Traumatic aortocaval fistula].

Arterio-venous fistula is a relatively rare form of vascular injury. A case of an unusual fistula between aorta and inferior vena cava is presented. Occasionally this type of injury is difficult to diagnose early. Life-threatening conditions may mandate prompt treatment and the use of damage control strategy. It is also important to diagnose and treat this injury in order to prevent complications. Sudden hemorrhage and congestive heart failure are the major disturbances that result from aortocaval fistula.

Comparison of the distribution of parvalbumin-immunoreactive and other synapses onto the somata of callosal projection neurons in mouse visual and somatosensory cortex.

The distribution of synapses made by parvalbumin-immunoreactive (pv-ir) and nonimmunoreactive terminals was determined for the cell bodies of callosal projection neurons in the somatosensory and visual areas of mouse cerebral cortex. Callosal neurons were labeled by the retrograde transport of horseradish peroxidase applied to the contralateral hemisphere. The surface areas of somata belonging to callosal cells in somatosensory cortex ranged from 230 to 243 microm2 in size and received roughly one-third of their synapses from pv-ir terminals. Visual cortex, in contrast, contained two populations of callosal cell bodies: relatively large ones ranging in size from 255 to 279 microm2 that received 3-9% of their synapses from pv-ir terminals and smaller cell bodies that both in size (232-237 microm2) and in the proportion of synapses received from pv-ir terminals resemble the callosal cells examined in somatosensory cortex. That different functional areas of the cortex have populations of callosal cells similar in size, and displaying similar patterns of somatic synapses, supports the notion that a common plan of synaptic connectivity characterizes different functional areas. Results in visual cortex indicate that functional areas contain, in addition, area-specific patterns of synapses.

Synapses of extrinsic and intrinsic origin made by callosal projection neurons in mouse visual cortex.

Neurons in areas 17/18a and 17/18b of mouse cerebral cortex were labeled by the retrograde transport of horseradish peroxidase (HRP) transported from severed callosal axons in the contralateral hemisphere. Terminals of the local axon collaterals of labeled neurons (intrinsic terminals) were identified in the border regions of area 17 with areas 18a and 18b, and their distribution and synaptic connectivity were determined. Also examined were the synaptic connections of extrinsic callosal axon terminals labeled by lesion-induced degeneration consequent to the severing of callosal fibers. A postlesion survival time of 3 days was chosen because by this time the extrinsic terminals were all degenerating, whereas the intrinsic terminals were labeled by horseradish peroxidase. Both intrinsic and extrinsic callosal axon terminals occurred in all layers of the cortex where, with rare exception, they formed asymmetrical synapses. Layers II and III contained the highest concentrations of intrinsic and extrinsic callosal axon terminals. Analyses of serial thin sections through layers II and III in both areas 17/18a and 17/18b yielded similar results: 97% of the intrinsic (1,412 total sample) and of the extrinsic (414 total sample) callosal axon terminals synapsed onto dendritic spines, likely those of pyramidal neurons; the remainder synapsed onto dendritic shafts of both spiny and nonspiny neurons. Thus, the synaptic output patterns of intrinsic vs. extrinsic callosal axon terminals are strikingly similar. Moreover, the high proportion of axospinous synapses formed by both types of terminal (97%) contrasts with the proportion of asymmetrical axospinous synapses that occurs in the surrounding neuropil where about 64% of the asymmetrical synapses are onto spines. This result is in accord with previous quantitative studies of the synaptic connectivities of callosal projection neurons in mouse somatosensory cortex, and lends additional weight to the hypothesis that axonal pathways are highly selective for the types of elements with which they synapse.

A simplified approach to retrograde/anterograde axonal labeling using combined injections of horseradish peroxidase and ibotenic acid.

Combined injections of ibotenic acid and horseradish peroxidase (HRP) were made into the region of the mouse ventrobasal thalamus that is related to the large mystacial vibrissae. Examination 4 and 5 days later of the corresponding area of the primary somatosensory cortex (i.e., barrel cortex), in thick and in thin sections, showed it to contain numerous corticothalamic projection cells the somata, dendrites and axons of which were densely labeled by the retrograde transport of HRP. Analysis of serial thin sections showed that thalamocortical axon terminals, which had degenerated in response to the injection of ibotenic acid, formed approximately 20% of the asymmetrical synapses in barrel cortex. The fine structure and distribution in cortex of degenerating thalamocortical axon terminals and of intrinsic HRP-labeled corticothalamic axon terminals were identical to those reported in previous studies in which the injection of HRP into the thalamus was combined with the making of electrolytic lesions. This indicates that injecting ibotenic acid is an effective replacement for electrolytic lesioning of the thalamus. The combined injection of ibotenic acid and HRP represents a new and efficient approach for studying reciprocal projection pathways.

Synapses made by axons of callosal projection neurons in mouse somatosensory cortex: emphasis on intrinsic connections.

This is one of a series of papers aimed at identifying the synaptic output patterns of the local and distant projections of subgroups of pyramidal neurons. The subgroups are defined by the target site to which their main axon projects. Pyramidal neurons in areas 1 and 40 of mouse cerebral cortex were labeled by the retrograde transport of horseradish peroxidase (HRP) transported from severed callosal axons in the contralateral hemisphere. Terminals of the local axon collaterals of these neurons ("intrinsic" terminals) were identified in somatosensory areas 1 and 40, and their distribution and synaptic connectivity were examined. Also examined were the synaptic connections of "extrinsic" callosal axon terminals labeled by lesion induced degeneration consequent to the severing of callosal fibers. A post-lesion survival time of 3 days was chosen because by this time the extrinsic terminals were all degenerating, whereas the intrinsic terminals were labeled by HRP. Both intrinsic and extrinsic callosal axon terminals occurred in all layers of the cortex where they formed only asymmetrical synapses. Layers II and III contained the highest concentrations of both types of callosal axon terminal. Analyses of serial thin sections through layers II and III in both areas 1 and 40 yielded similar results: 97% of the extrinsic (277 total sample) and of the intrinsic (1215 total sample) callosal axon terminals synapsed onto dendritic spines, likely those of pyramidal neurons; the remainder synapsed onto dendritic shafts of both spiny and nonspiny neurons. Thus the synaptic output patterns of intrinsic vs. extrinsic callosal axon terminals are strikingly similar. Moreover, the high proportion of axospinous synapses formed by both types of terminal contrasts with the proportion of asymmetrical, axospinous synapses that occur in the surrounding neuropil where only about 80% of the asymmetrical synapses are onto spines. This result is in accord with previous quantitative studies of the synaptic connectivities of both extrinsic and intrinsic axonal pathways in the cortex (White and Keller, 1989: Cortical Circuits; Boston: Birkhauser): in all instances, axonal pathways are highly selective for the types of elements with which they synapse.