Injury profiles in pedestrian motor vehicle trauma.

One hundred fifteen consecutive pedestrians who were struck by motor vehicles were studied to determine the magnitude and patterns of the injuries sustained. The mortality rate was 22%, and 17 of 25 patients who died did so during the initial resuscitative efforts, primarily due to head, chest, and or abdominal injury. The average Injury Severity Score (ISS) among all patients was 20; however, it was significantly higher (46) in nonsurvivors. The majority of the victims were men (72%), and the average age of all patients was 35 years. As the patient's age increased, so did the likelihood of mortality, fractures, and prolonged hospital stay. Blood alcohol levels were measured in 85 patients, 65% of whom had detectable levels (mean, 0.25 mg/dL). There was no correlation between the presence of alcohol and mortality, ISS, head injury, or number of fractures. The most frequently injured organ system was musculoskeletal (77%), followed by head (34%), abdomen (21%), and chest (15%). The most common fractures seen were tibia-fibular (39), pelvis (35), and femur (31). Hospital stay averaged 11 days, and patients charges averaged $16,900.

DNA ploidy, grade, and stage in prognosis of uterine cervical cancer.

A retrospective study of 56 cases of uterine cervical squamous carcinoma evaluated DNA content, histological grade, and clinical stage as indicators of prognosis. Minimum survivor follow-up was 24 months. Following standard radiation therapy, there were 40 cures and 16 treatment failures. DNA content was measured by flow cytometry of pretreatment biopsies removed from paraffin. There were 18 diploid cases and 38 aneuploid (67.9%). Aneuploid cases included 6 with very high G2-M peaks (greater than or equal to 15% of the cell sample). DNA ploidy correlation with prognosis was not statistically significant. However, both grading by a multiple parameter method (P less than 0.0133) and staging (P less than 0.0064) were significant prognostic factors. Higher grade and stage correlated with treatment failure.

Transcutaneous oxygen and carbon dioxide pressure monitoring to determine severity of limb ischemia and to predict surgical outcome.

Transcutaneous oxygen and carbon dioxide pressure (PO2 and PCO2) foot monitoring was compared with ankle Doppler-derived systolic pressure regarding their respective abilities to discriminate the severity of limb ischemia before vascular reconstruction and to predict surgical outcome early in the postoperative period. Transcutaneous PO2 (tcPCO2), foot-chest tcPO2 index, transcutaneous PCO2 (tcPCO2), foot tcPO2/tcPCO2 index (tcPO2/tcPCO2), ankle Doppler systolic pressure (AP), and ankle-brachial pressure index (ABI) were determined in 89 revascularized limbs. The measurement of tcPO2 and foot-chest tcPO2 was found to be more sensitive to degrees of severity of limb ischemia and more closely associated with the outcome of revascularization than AP and ABI. TcPCO2 and tcPO2/tcPCO2 were not useful in assessment of the vascular patient undergoing reconstructive surgery. Before operation, tcPO2 less than or equal to 22 torr and foot-chest tcPO2 less than or equal to 0.46 indicate severe limb ischemia requiring urgent revascularization. After operation, tcPO2 less than or equal to 22 torr and foot-chest tcPO2 index less than or equal to 0.53 indicate that revascularization is likely to fail. We conclude that tcPO2 monitoring, as a metabolic test of actual tissue perfusion, is a more reliable indicator of preoperative limb ischemia and postoperative outcome of revascularization than hemodynamic, Doppler-derived pressure tests.

Computed radiographic evaluation of simulated pulmonary nodules. Preliminary results.

We evaluated the capabilities of a computed radiography system (CRS) and a standard radiography system (SRS) in the detection of simulated solitary pulmonary lung nodules of various sizes and contrast. A phantom simulated the pulmonary anatomy, and specially shaped plexiglass disks were externally mounted to simulate solitary pulmonary nodules of different diameters and thicknesses. ROC curves were generated based on the performance of each of the radiologists observing each film set. In this preliminary study, the overall performance for both the CRS and the SRS were comparable in detecting simulated pulmonary nodules.

Single versus triplicate measurements of blood pressure and heart rate.

The mean of rapidly repeated duplicate or triplicate measurements is often used in studies of antihypertensive drugs. Forty patients with hypertension had triplicate measurements of blood pressure and heart rate on two occasions, 1 week apart, during placebo treatment. The average difference between the first measurement and the mean of the triplicate measurements was -0.3 mm Hg. The average coefficient of variation for supine and standing, systolic and diastolic blood pressures was 8.4% for the single measurements and 8.0% for the mean of triplicate measurements. The correlations between the first measurements and the mean of triplicate measurements ranged from 0.90 to 0.98 (all p less than 0.01). The average difference between the two visits for all four blood pressure parameters was -0.6 mm Hg for the single measurements and -0.5 mm Hg for the mean of triplicate measurements (all p = NS). These results indicate that 1) blood pressure does not change further after 1 week of placebo treatment, and 2) use of the mean of triplicate measurements of blood pressure and heart rate gives the same result as use of single measurements, and the results are no less variable.

Mammogram interpretation by physician assistants.

The objective of this study was to determine whether a health maintenance organization (HMO) desirous of providing low-cost, quality mammography could employ physician assistants (PAs) to interpret mammograms under the supervision of HMO radiologists. After intensive training in mammographic interpretation, four PAs individually interpreted 727 mammograms of 470 normal breasts, 75 breasts with benign breast masses, and 182 breasts with cancer. The interpretations by the PAs were more sensitive and as specific as those made by six HMO radiologists who interpreted the same cases, and as effective as those by radiologists described in the literature. In receiver-operating-characteristic curve analysis, the areas under curves for PAs were larger than those under curves for radiologists. Interpretations by PAs took less time and cost less than did those by radiologists; the dispositions recommended by PAs were similar to those recommended by radiologists. We conclude that properly trained, evaluated, and supervised PAs can interpret mammograms. Legal, practical, and ethical considerations dictate that this can best be accomplished under the direction of radiologists who are well trained in mammography.

Prospective comparison of noninvasive techniques for amputation level selection.

This study prospectively compared the following tests for their accuracy in amputation level selection: transcutaneous oxygen, transcutaneous carbon dioxide, transcutaneous oxygen-to-transcutaneous carbon dioxide, foot-to-chest transcutaneous oxygen, intradermal xenon-133, ankle-brachial index, and absolute popliteal artery Doppler systolic pressure. All metabolic parameters had a high degree of statistical accuracy in predicting amputation healing whereas none of the other tests had statistical reliability. Amputation site healing was not affected by the presence of diabetes mellitus nor were the test results for any of the metabolic parameters.

Splenomimetic effect of Corynebacterium parvum in fulminant pneumococcemia.

The efficacy of Corynebacterium parvum to stimulate splenic growth and to boost host survival was examined by using adult Sprague-Dawley rats in a highly spleen-sensitive model of fulminant pneumococcemia. Rats were either treated (10 days or 1 hr before or 1 hr after) or not treated with C. parvum; were depleted of complement; underwent partial, total, or sham splenic resection; and then were challenged with either a low (2 X 10(2)) or a high (2 X 10(5)) dose of pneumococci. In the absence of C. parvum, survival (percent and duration) was lowest after total splenectomy and was proportional to remnant spleen weight after partial splenectomy. Although C. parvum treatment sharply increased splenic weight, nucleated cell numbers, and survival, the lowered mortality and improved survival time were independent of spleen weight. The rapidly acting, extrasplenic, splenomimetic protective effect of C. parvum suggests that this class of immunomodulators may be a useful adjunct in managing sepsis associated with defective or absent splenic function.

Fragile sites are unrelated to reciprocal translocation breakpoints.

In 492 cases of reciprocal translocations in balanced carriers, the 984 breakpoints were studied for a possible relationship to the 45 fragile sites. Random coincidence was predicted at 14% and the observed coincidence was 14.3%, indicating that the two events are unrelated. However, chromosomes 1, 11 and 14 were exceptions and did show a statistically significant relationship.

The anatomy of an obstetrical service.

Major technologic advancements have occurred in obstetrics allowing health care providers to offer improved perinatal outcome for the mother and child. However, because of rapid scientific progress, simple methods of improving health care are often overlooked. The study analyzed the anatomy of one year's deliveries at the authors' institution in an attempt to determine if changes in nursing or physician staffing would allow for a better perinatal outcome for their patients.

Evaluation of methodologic variables of the in vitro lymphocyte transformation assay.

Optimum methodologic variables for assessing cellular immunity by in vitro lymphocyte transformation (LT) were determined using spherulin and coccidioidin antigens. This study was conducted in an area endemic for coccidioidomycosis and included healthy, coccidioidomycosis skin test positive (STP) and negative (STN) subjects, and patients with mild, acute disease. The authors examined the relationship between coccidioidin (1:100) and spherulin (low dose) skin test reactivity and lymphocyte transformation (LT) responses to the same antigens. Counts per minute (CPM) and stimulation index (SI) as methods of expressing tritiated thymidine uptake were compared. The LT assays were set up in duplicate test systems using autologous and homologous plasma. Both antigens differentiated between STP and STN groups (P less than or equal to 0.001-0.004), but values obtained with spherulin-induced LT were greater than those using coccidioidin (P less than 0.001). Values in CPM and SI were greater in the spherulin-induced LT assay using autologous compared with AB plasma. Specifically, for detecting cellular immunity to coccidioidomycosis, the combination of spherulin-induced LT using autologous plasma and expressing the results in CPM gave the best discrimination between STP and STN subjects. Based on epidemiologic data, the latter method also appeared more sensitive than the skin test in detecting cellular immunity to coccidioidomycosis. In general, these data illustrate the variable effectiveness of different antigens for inducing LT responses and further show how different plasma sources affect the LT response. Finally, these data suggest that lymphocyte blast transformation results expressed as CPM may give more consistent values and better discrimination between immune and nonimmune subjects than results expressed as stimulation indices.

The prevalence of cellular immunity to coccidioidomycosis in a highly endemic area.

Intradermal skin test reactivity to spherulin and coccidioidin and in vitro spherulin-induced lymphocyte transformation were used to assess cellular immunity in healthy subjects and patients with acute, self-limited coccidioidomycosis (cocci). The objectives of this study were to evaluate the relative sensitivities of the two assays in assessing cellular immunity to cocci, especially in long-term residents of an endemic area (Tucson) and, based on data from both assays, determine the prevalence of detectable cellular immunity to cocci in this highly endemic area. The lymphocyte transformation assay appeared to be more sensitive than the skin test in assessing long-term immune status, and the prevalence of detectable immunity to cocci in this highly endemic area was only 75% in long-term residents. This is much lower than previous prevalence estimates (90%) in other endemic areas. The absence of a demonstrable cell-mediated immunity may indicate either no prior antigen exposure (infection) or previous remote exposure with a diminished immune response (no reexposure to boost immunity). A possible explanation for the lower prevalence of immunity to cocci in this endemic area may relate to the increased urbanization of the Southwest in the past several years. Therefore, the clinical suspicion of acute cocci should not be restricted to recent arrivals to endemic areas.

Balanced reciprocal translocations: risk factors for aneuploid segregant viability.

Reciprocal translocations were studied in two groups of balanced carrier couples: 202 had 210 translocation aneuploid between (LB) infants, and 95 couples had repetitive abortions (AB) without liveborn aneuploids. The observed translocation aneuploidies in the LB group were compared to predicted potential aneuploidies in AB by frequency of chromosome involvement, meiotic segregation mode, and mean trisomic, monosomic and combined genomic imbalances. Qualitative and quantitative differences identified genomic regions and chromosomes possibly vital for in utero survivability. LB aneuploidies indicate non-random chromosome involvement, selection of least detrimental segregants and segments, and predominant transmission from maternal balanced carriers (especially in 3:1 tertiary segregation, 93.5%). For an individual with a balanced reciprocal translocation and untested reproductive capability, an approach is given for predicting whether a translocation aneuploid conceptus will be liveborn or aborted.

The genetic and demographic impact of immigrants in a largely endogamous community.

Historical demographic data extending back approximately 300 years were analysed to determine the demographic and genetic impact of in-migrants to an endogamous Swiss Alpine village. In-migrants were involved in only 14% of the marriages recorded in the village. In addition, only slightly more than 50% of the in-migrants were represented in the 1970 gene pool of the village. However, in-migrants accounted for nearly 38% of this gene pool. This seemingly anomalous situation can be explained by the fact that while the fertility of in-migrants and the marriage rate among their children are reduced (accounting for the near 50% "drop-our rate" of in-migrants from the gene pool), the fertility of the children of in-migrants and the marriage rate among the grandchildren of in-migrants are increased relative to village natives (accounting for the high proportion of genes in the gene pool ultimately attributable to in-migrants). Our results clearly demonstrate that although this community forms an endogamous population, it is definitely not a genetic isolate. Other investigators are cautioned against automatic invocation of the simplifying (and, thus, extremely tempting) assumption that endogamy is equivalent to genetic isolation.

Divorce, remarriage, and fertility in a Micronesian population.

PIP: Demogrpahic data for the island of Yap in Micronesia indicate 3 significant features: 1) the Yapese have very high marriage and divorce rates; 2) fertility is much higher for women born after 1926 than for older women; and 3) there is a statistically significant negative correlation between number of spouses and number of pregnancies in women born before 1926 and a positive correlation for women born after 1926. It has been argued that this is due to the prevalence of genito-urinary disease in the Yapese population prior to World War 2, since this disease is known to have adverse effects on fertility. The more sexual partners a woman had, the greater her chances of contracting the disease. When the United States government introduced antibiotics to the island in 1946, the situation changed. It is proposed that marriage and divorce customs prior to World war 2 are an example of a maladaptive cultural practice which contributed to the declining population of the island.^ieng