Primary skin closure after damage control laparotomy.

BACKGROUND: Damage control laparotomy (DCL) is used widely in the management of patients with traumatic injuries but carries significant morbidity. Surgical-site infection (SSI) also carries potential morbidity, increased costs and prolonged hospital stay. The aim of this study was to determine whether primary skin closure after DCL increases the risk of SSI. METHODS: This was a retrospective institutional review of injured patients undergoing DCL between 2004 and 2012. Outcomes of patients who had primary skin closure at the time of fascial closure were compared with those of patients whose skin wound was left open to heal by secondary intention. The association between skin closure and SSI was evaluated using propensity score-adjusted multivariable logistic regression. RESULTS: Of 510 patients who underwent DCL, primary fascial closure was achieved in 301. Among these, 111 (36.9 per cent) underwent primary skin closure and in 190 (63.1 per cent) the skin wound was left open. Fascial closure at the initial take-back surgery was associated with having skin closure (P < 0.001), and colonic injury was associated with leaving the skin open (P = 0.002). On multivariable analysis, primary skin closure was associated with an increased risk of abdominal SSI (P = 0.020), but not fascial dehiscence (P = 0.446). Of patients receiving skin closure, 85.6 per cent did not develop abdominal SSI and were spared the morbidity of managing an open wound at discharge. CONCLUSION: Primary skin closure after DCL is appropriate but may be associated with an increased risk of SSI.

Dosimetric characteristics of the bests double-wall 103Pd brachytherapy source.

103Pd and 125I brachytherapy sources are being used for interstitial implants in tumor sites such as the prostate. Recently, a double-wall 103Pd source has been introduced, which has a design different from that of sources presently on the market. Dosimetric characteristics (dose rate constant, radial dose function, and anisotropy function) of this source were experimentally and theoretically determined following the AAPM Task Group 43 recommendations and were related to the October 10, 2000 revision of the NIST 1999 SK Standard for 103Pd. Measurements were performed in a Solid Water phantom using LiF thermoluminescent dosimeters. For these measurements, slabs of Solid Water phantom material were machined to accommodate the source and LiF TLD chips of dimensions (3.1 x 3.1 x 0.8 mm3) and (1.0 x 1.0 x 1.0 mm3). The TLD chips were surrounded by at least 10 cm of Solid Water phantom material to provide full scattering conditions. The Monte Carlo simulations were performed in Solid Water and liquid water using the PTRAN code. The results of this investigation show an excellent agreement (within 5%) between the measured (0.67+/-8% cGy h(-1) U(-1)) and calculated (to be 0.65+/-3% cGy h(-1) U(-1)) dose rate constant in Solid Water. The Monte Carlo calculated dose rate constant of the Best 103Pd in water was found to be 0.67+/-0.02 cGy h(-1) U(-1). The radial dose function, g(r), of the new 103Pd source was measured at distances ranging from 0.5 and 7 cm using LiF TLD in Solid Water phantom material. Moreover, the radial dose function of the new source was calculated in liquid water and Solid Water at distances ranging from 0.1 to 7 cm using the PTRAN Monte Carlo Code. The anisotropy function, F(r, theta), of the new 103Pd source was also measured in Solid Water and calculated in both Solid Water and water phantom material. From the anisotropy functions, the anisotropy factors, and anisotropy constant were calculated for each medium. The results indicated that the measured anisotropy constant of the Best 103Pd source in Solid Water was 0.89+/-5%. Complete dosimetric data are described in this manuscript.

Dosimetric characteristics of a new 125I brachytherapy source.

125I brachytherapy sources are being used for interstitial implants in tumor sites such as the prostate. Recently, a new 125I source has been introduced, which has a design different from that of other sources presently on the market. Dosimetric characteristics of this source, including dose rate constant, radial dose function, and anisotropy function, were determined experimentally following the AAPM Task Group 43 recommendations. The characteristics were related to the 1999 NIST calibration assigned to this source [SK,99std]. Measurements were performed in a solid water phantom using LiF thermoluminescent dosimeters. For these measurements, slabs of solid water phantom material were machined to accommodate the source and LiF TLD chips of dimensions (3.1 x 3.1 x 0.8 mm3) and (1.0 x 1.0 x 1.0 mm3). The TLD chips were surrounded by at least 10 cm of solid water phantom material to provide full scattering conditions. The results indicated a dose rate constant, lambda, of 0.88 +/- 0.07cGyh(-1)U(-1) for the new 1251 source as compared to 0.98 and 1.04 cGy h(-1)U(-1) for the Nycomed/Amersham model 6711 and 6702 seeds, respectively. Per TG-43, the values reported here represent the dose absorbed by water at 1 cm from the source in a water medium. The radial dose function, g(r), of the new 125I source was measured at distances ranging from 0.5 to 10 cm. The anisotropy function, F(r,theta), of the new 125I source was measured at distances of 2 and 5 cm from the source center. Calculations of anisotropy and radial dose function were also made using a Monte Carlo code. These calculations were made for both solid water and liquid water, the former to validate the Monte Carlo code and the latter to provide results in liquid water for clinical use. All data compared favorably with those from the Nycomed/Amersham models 6711 and 6702 sources.

Experimental determination of dosimetric characteristics of Best 125I brachytherapy source.

125I brachytherapy sources are being used for interstitial implants in tumor sites such as the prostate. Recently, the Best 125I source became commercially available for interstitial brachytherapy treatment. Dosimetric characteristics (dose rate constant, radial dose function, and anisotropy function) of this source were experimentally determined, following the AAPM Task Group 43 recommendations, and were related to the NIST 1999 calibration assigned to this source. Measurements were performed in Solid Water phantom using LiF thermoluminescent dosimeters. The results indicated a dose rate constant, lambda, of 1.01 +/- 0.08 cGy h(-1) U(-1) for the new source. The radial dose function, g(r), of the new source was measured at distances ranging from 0.5 to 10.0 cm. The anisotropy function, F(r, theta), of the new source was measured at distances of 2, 5, and 7 cm from the source center. These data compare favorably with those from the Nycomed/Amersham Models 6711 and 6702 sources. The anisotropy constant, phi(an), of the Best 125I source was found to be 0.982. Complete dosimetric parameters of the new source are presented in this paper.

Dosimetric characteristics of the Pharma Seed model BT-125-I source.

125I brachytherapy sources are being used with increasing frequency for interstitial implants in tumor sites, especially the prostate. Recently, a new 125I source design has become commercially available for clinical applications. Dosimetric characteristics (i.e., dose rate constant, radial dose function, and anisotropy function) of this source were experimentally and theoretically determined following the AAPM Task Group 43 (TG-43) recommendations and were related to the 1999 NIST calibration assigned to this source [S(k), 99std]. Measurements were performed in a Solid Water phantom using LiF thermoluminescent dosimeters. The measured data were used to validate the Monte Carlo simulations that were performed in Solid Water using the PTRAN code. The Monte Carlo calculations were then performed in liquid water to obtain the dosimetric information for clinical applications in accordance with TG-43 recommendations. The results indicated that the dose rate constant, lambda, of the Pharma Seed model BT-125-I 125I source was 0.90 +/- 0.06 cGy h(-1) U(-1) using thermoluminescent dosimeter (TLD) measurements and 0.92 +/- 0.03 cGy h(-1) U(-1) using Monte Carlo simulations in Solid Water. The calculated value in liquid water was found to be 0.95 +/- 0.03 cGy h(-1) U(-1). The radial dose function, g(r), of the new 125I source was measured at distances ranging from 0.5 to 10 cm using LiF TLD in Solid Water phantom material. The Monte Carlo simulations were performed for distances ranging from 0.1 to 10 cm from the source center in Solid Water and liquid water. The anisotropy function, F(r, theta), was measured at distances of 2, 5, and 7 cm from the source center and calculated at distances of 0.5, 1, 2, 3, 5, and 7 cm from the source center. The anisotropy constant, phi(an), of the Pharma Seed source in water was found to be 0.975. Complete dosimetric data are described in this manuscript. Per TG-43, the values reported in water should be used for clinical treatment planning systems.

Dosimetric characteristics of the InterSource103 palladium brachytherapy source.

103Pd brachytherapy sources are being used for interstitial implants in tumor sites such as the prostate. Recently, the InterSource103 palladium source has been introduced, which has a design different from that of other sources presently on the market. Dosimetric characteristics (i.e., dose rate constant, radial dose function, and anisotropy function) of this source were experimentally and theoretically determined following the AAPM Task Group 43 (TG-43) recommendations and were related to the 1999 NIST calibration assigned to this source [Sk, 99std]. Measurements were performed in a solid water phantom using LiF thermoluminescent dosimeters. The measured data was compared with Monte Carlo simulations performed in solid water using the PTRAN code. The calculations were then performed in liquid water to obtain the dosimetric information for clinical applications as per TG-43 recommendation. The results indicated that the dose rate constant, lambda, of the InterSource103 palladium source was 0.664+/-5% cGy/h/U using TLD measurements and 0.660+/-3% cGy/h/U using Monte Carlo simulations in solid water. The calculated value in liquid water was found to be 0.696 +/- 3 % cGy/h/U. The radial dose function, g(r), of the new 103Pd source was measured at distances ranging from 0.5 to 10 cm using LiF TLD in solid water phantom material. The Monte Carlo simulations were performed at distances ranging from 0.1 to 10 cm from the source center in solid water and liquid water. The anisotropy function, F(r, theta), was measured at distances of 2, 3, 5, and 7 cm from the source center and calculated at distances of 0.5, 1, 2, 3, 5, and 7 cm from the source center. Complete dosimetric data are described in this paper. Per TG-43, the values reported in water should be used for clinical treatment planning systems.

What is the leading cause of infant mortality? A note on the interpretation of official statistics.

OBJECTIVES: According to vital statistics reports, congenital malformation is the leading cause of infant death in the United States and accounts for a much greater proportion of infant mortality than does premature birth. The purpose of this study was to examine the potential underestimation of prematurity-related mortality in current vital statistics reports. METHODS: National mortality data from 1985, 1991, and 1996 were analyzed. RESULTS: The official statistics significantly understate the role of prematurity-related mortality. An alternative etiology-based classification designates prematurity as the underlying cause in approximately one third of all infant deaths. CONCLUSIONS: Although no single scheme is suitable for every objective, analysts and policymakers should recognize the degree to which technical classification practices can influence the apparent importance of various causes of death.

Premature birth and the changing composition of newborn infectious disease mortality: reconsidering "exogenous" mortality.

Linked death and birth records from San Antonio, Texas revealed that infectious infant mortality is increasingly a function of premature birth and low birth weight. Between 1935 and 1944, 4% of infectious infant deaths had associated causes involving prematurity and related conditions; by 1980, 25% of infectious infant deaths involved prematurity and more than 40% of those infants weighed less than 2,500 grams. The shift in birth-weight composition results almost entirely from an increase in very low-weight births. Under conditions of advanced perinatal technology, infectious infant mortality should no longer be viewed as wholly exogenous. These findings further undermine the contemporary relevance of the exogenous-endogenous distinction.