Abdominal injuries after high falls: high incidence and increased mortality.

BACKGROUND: Falls from height are a major cause of morbidity and mortality. Injuries to the extremities and head are common. However, little has been reported on abdominal injuries or their treatment. This study aims to assess the abdominal injuries, treatment, and mortality after falls from height. METHODS: We searched our hospital's Trauma registry from January 2004 through December 2007 and identified all patients who fell from five meters or higher. Additional data was extracted from medical records, radiology reports, and operation reports. RESULTS: One hundred and thirty-nine patients (median age 31 years) were included. There were 106 men and 33 women. Forty-one patients had abdominal injuries. Thirteen patients had a retroperitoneal hematoma, eleven had a liver laceration, nine had a kidney laceration, and eight had a spleen laceration. Eleven patients required emergency laparotomy and/or endovascular stenting or coiling to stop the bleeding. Patients with abdominal injuries had a tenfold higher mortality than those without abdominal injuries (19.5% versus 2.0%). CONCLUSION: Abdominal injuries were common and associated with a tenfold increase in mortality.

Staircase falls: high-risk groups and injury characteristics in 464 patients.

INTRODUCTION: Few data are available about the epidemiology and injury characteristics in staircase falls. The available literature mainly concerns children and autopsy studies. OBJECTIVE: To describe the epidemiology and injury characteristics of staircase falls, and to identify high-risk groups for these falls. METHODS: All patients who reported to an academic Accident & Emergency (A&E) department in 2005 after a staircase fall were selected in the Dutch Injury Surveillance System These data were linked to the hospital Trauma Registry database. RESULTS: Four hundred and sixty-four patients (42% male, p=0.001), with a median age of 35 years were included. Children under five suffered significantly more head injuries. Male patients showed significantly more thoracic injuries than female patients. Spinal column fractures were only seen in patients over 25 years of age. Older patients tended to accumulate more rib fractures and lower extremity fractures and were admitted more frequently than the younger patients. Sixty-one patients (13%) required admission. Two patients, both with severe traumatic brain injury (TBI), died. National data on staircase falls were comparable with our hospital data. However, in comparison to the national population data, senior citizens in this study had an incidence that was markedly higher than in the younger patients. CONCLUSION: Injuries due to staircase falls occur in all age groups, however, children under five years are relatively over-represented with higher rates of head injury. Senior citizens showed a markedly higher incidence than younger patients. Most injuries occur to the distal extremities and are relatively mild.

High protein intake sustains weight maintenance after body weight loss in humans.

BACKGROUND: A relatively high percentage of energy intake as protein has been shown to increase satiety and decrease energy efficiency during overfeeding. AIM: To investigate whether addition of protein may improve weight maintenance by preventing or limiting weight regain after weight loss of 5-10% in moderately obese subjects. DESIGN OF THE STUDY: In a randomized parallel design, 148 male and female subjects (age 44.2 +/- 10.1 y; body mass index (BMI) 29.5 +/- 2.5 kg/m2; body fat 37.2 +/- 5.0%) followed a very low-energy diet (2.1 MJ/day) during 4 weeks. For subsequent 3 months weight-maintenance assessment, they were stratified according to age, BMI, body weight, restrained eating, and resting energy expenditure (REE), and randomized over two groups. Both groups visited the University with the same frequency, receiving the same counseling on demand by the dietitian. One group (n=73) received 48.2 g/day additional protein to their diet. Measurements at baseline, after weight loss, and after 3 months weight maintenance were body weight, body composition, metabolic measurements, appetite profile, eating attitude, and relevant blood parameters. RESULTS: Changes in body mass, waist circumference, REE, respiratory quotient (RQ), total energy expenditure (TEE), dietary restraint, fasting blood-glucose, insulin, triacylglycerol, leptin, beta-hydroxybutyrate, glycerol, and free fatty acids were significant during weight loss and did not differ between groups. During weight maintenance, the 'additional-protein group' showed in comparison to the nonadditional-protein group 18 vs 15 en% protein intake, a 50% lower body weight regain only consisting of fat-free mass, a 50% decreased energy efficiency, increased satiety while energy intake did not differ, and a lower increase in triacylglycerol and in leptin; REE, RQ, TEE, and increases in other blood parameters measured did not differ. CONCLUSION: A 20% higher protein intake, that is, 18% of energy vs 15% of energy during weight maintenance after weight loss, resulted in a 50% lower body weight regain, only consisting of fat-free mass, and related to increased satiety and decreased energy efficiency.

Comparison of a self-administered questionnaire and a telephone interview of 146 Danish waste collectors.

Methods to collect epidemiologic data include, among other means, self-administered questionnaires and personal and telephone interviews. In some studies, these data collection methods are used simultaneously. However, little is known about the comparability of the data obtained, thus, the validity of pooling data. A self-administered questionnaire was completed by 146 waste collectors, who participated in a telephone interview 3 months later. The responses to health questions were compared. Agreement percentages and kappa values were calculated. An answer pattern shift was detected in a subgroup of questions with five answer options. Grouping the answer options diminished the shift in the answer pattern. The questions in a yes/no format generally showed no shift in the answer pattern. The study indicates that caution should be exercised when pooling data collected by self-administered questionnaire and telephone interview in epidemiological research. Some types of questions seem to be sensitive to the data collection method.

Increased incidence of cytogenetic abnormalities in chorionic villus samples from pregnancies established by in vitro fertilization and embryo transfer (IVF-ET).

We studied 201 pregnancies that were established by in vitro fertilization and embryo transfer (IVF-ET) and compared the frequency of cytogenetic abnormalities with that found in a large control population matched for indication group (advanced maternal age) and time of sampling. A total of 252 IVF-ET fetuses were cytogenetically analysed by either chorionic villus sampling (CVS; n = 80) or amniocentesis (n = 172). Eleven chromosome abnormalities were found in the CVS group (13.8 per cent); among them, a 45,X/46,X,dic(Y)(q11)/46,X,del(Y)(q11) mosaic that was found in an IVF pregnancy established by intracytoplasmic sperm injection (ICSI), four cases of trisomy 21, and three cases of trisomy 7 confined to the placenta. The results indicate a statistically significant three- to five-fold increase in both confined placental abnormalities (P < 0.008) and true fetal chromosome anomalies (P < 0.04). In the amniocentesis group, identical rates (1.7 per cent) of chromosome abnormalities were found in the IVF-ET and control groups. It is concluded that late first trimester, but not early second trimester, IVF-ET pregnancies are characterized by an increased frequency of cytogenetic abnormalities found at prenatal diagnosis.