ABSTRACT
One hundred ten fractures due to gunshots were reviewed to examine the medical, social, and financial implants of such injuries. The population was predominantly male (91%), unemployed (56%), and uninsured (79%). Sixty-eight percent were documented substance abusers, and 65% of the injuries appeared to be related to illicit drug activities. There were 94 long bone fractures and 16 intraarticular fractures. Early operative treatment was employed in 64 patients (58%) with formal internal fixation in 31. There was no difference between type of treatment, associated injury variables, and outcome, and no increase in complications with acute operative management employing internal fixation. Medical charges averaged $13,108 per patient, a 1200% increase over injuries treated at this institution in 1972 and a rise far in excess of the medical care inflation rate (334%) during the same period.
Subject(s)
Fractures, Bone/epidemiology , Fractures, Bone/etiology , Wounds, Gunshot/complications , Adolescent , Adult , Cost-Benefit Analysis , Fees and Charges , Female , Fracture Fixation/economics , Fracture Fixation/methods , Fractures, Bone/classification , Fractures, Bone/economics , Fractures, Bone/therapy , Humans , Male , Middle Aged , Retrospective Studies , Socioeconomic Factors , Substance-Related Disorders/complications , Substance-Related Disorders/epidemiology , Treatment OutcomeABSTRACT
By use of ion exchange chromatography we have isolated two discrete classes of "free" glycosaminoglycans (GAG) from human plasma. The GAG fractions were tested for their effects on two lipoprotein lipase (LPL) enzyme systems containing an apolipoprotein C-II activated emulsion as the triglyceride substrate and bovine serum albumin as the free fatty acid acceptor. The lowcharge GAG (Fraction I) had essentially no effect on the LPL reaction. The high-charge GAG (Fraction II) stimulated the LPL reaction 100 to 300%. The GAG composition of each fraction was investigated with chemical and enzymatic techniques. Fraction I consisted of low-charge chondroitin sulfate noncovalently bound to protein. Fraction II consisted of a mixture of high-charge GAG non-covalently bound to protein. Degradation with nitrous acid eliminated the ability of high-charge GAG to stimulate LPL. This and other evidence suggests that the high-charge GAG in human plasma responsible for LPL activation is heparan sulfate (HS). We suggest that plasma HS may modulate triglyceride clearance mechanisms in vivo by its interaction with LPL.
