Serum hormone concentrations relative to carcass composition of a random allotment of commercial-fed beef cattle.

Cattle (n = 995 steers and 757 heifers) were randomly selected from a commercial abattoir (Emporia, KS) to determine the relationships between USDA quality and yield grade characteristics and serum concentrations of leptin, IGF-I, and GH. Animals were randomly selected postexsanguination on the slaughter line on 4 occasions (March, May, August, and January). Blood was collected at exsanguination and transported to the University of Missouri for analysis. Sex and hide color were recorded. Carcass data included HCW, 12th-rib fat thickness, KPH, LM area, and marbling score, which were collected from each carcass approximately 24 h postmortem. Average serum leptin concentrations were greater (P = 0.008) for heifers (11.9 ng/mL) than steers (10.9 ng/mL). Heifers had lighter carcasses (331.9 vs. 352.2 kg, P < 0.001), greater 12th-rib fat measurements (1.3 vs. 1.1 cm, P < 0.001), greater KPH (2.5 vs. 2.4%, P < 0.001), and more marbling (Small(40) vs. Small(10), P < 0.001) than steers. Positive correlations (P < 0.01) existed between leptin concentration and marbling score (r = 0.28), 12th-rib fat depth (r = 0.37), KPH (r = 0.23), and USDA yield grade (r = 0.32). Negative correlations were found between leptin and IGF-I (r = -0.11; P < 0.001) and leptin and GH (r = -0.32; P < 0.001). Negative correlations (P < 0.01) were observed for IGF-I and KPH (r = -0.23) and marbling score (r = -0.20), whereas GH was most highly negatively correlated with KPH (r = -0.23; P < 0.001). Leptin concentration accounted for variation (P < 0.001) in a model separating least squares means across USDA quality grade, separating USDA standard (8.5 ng/mL), select (10.3 ng/mL), low choice (12.2 ng/mL), and upper 2/3 choice/prime (>12.9 ng/mL) carcasses. There was no difference (P = 0.31) observed in leptin concentrations between the upper 2/3 choice and prime carcasses (12.9 and 14.2 ng/mL, respectively). Relationships within endocrine profiles and between endocrine concentrations and carcass quality characteristics may prove to be a useful tool for the prediction of beef carcass composition.

Venous thrombosis incidence in burn patients: preliminary results of a prospective study.

There are few prospective data on the incidence of deep venous thrombosis (DVT) in burn patients. In an on-going prospective study, hospitalized burn patients 18 years or older with an expected hospital length of stay more than 72 hours were imaged with baseline venous duplex ultrasound of all extremities within the first 48 hours after admission and weekly until discharge. Patient demographics and clinical risk factors for DVT were assessed. At the time of submission, 40 patients met screening criteria, and 30 were enrolled. Ultrasound diagnosed seven patients with 11 acute DVT for an incidence of 23%. One pulmonary embolism was documented. DVT patients had a mean age of 49 +/- 23 years with an average TBSA burn of 15 +/- 4% compared with those without thrombosis with a mean age of 44 +/- 17 years (P = NS) and TBSA burn of 18 +/- 25% (P = NS). There were no statistically significant differences for DVT patients in terms of age, number of central line days, hospital length of stay, or TBSA burned. Given the preliminary findings of this small study, we believe that all hospitalized burn patients are at risk for DVT. On-going investigation will be helpful in defining level of risk and improved prevention strategies for thromboembolic complications in burn patients.

The utility of endovascular stents in the treatment of blunt arterial injuries.

BACKGROUND: The objective of this review is to evaluate our institutional experience with percutaneously placed vascular stents in multiply injured patients with blunt arterial injuries. METHODS: Patients were identified through our trauma registry from 9/95 through 12/99. All injuries were diagnosed by angiography. Palmaz and Wallstent prostheses were used. RESULTS: Six patients had blunt arterial injuries. Age ranged from 20 to 67 years (average, 45). Each patient had one or more stents placed. There were no immediate complications related to stent placement. There were no deaths or complications attributable to stent placement. All of the patients survived to leave the hospital. Follow-up ranged from 1 month to 2 years with no occlusion, stenosis, or stent malfunction. CONCLUSION: The use of interventional angiography and endovascular stenting is safe and efficacious in treating arterial injuries in certain circumstances.

Potential risk factors for deep venous thrombosis in burn patients.

Risk factors and prophylaxis for prevention of deep venous thrombosis (DVT) and pulmonary embolism remain controversial in burn patients. From January 1996 through June 1999, we reviewed all adult burn patients admitted to our burn center with the in-hospital diagnosis of DVT and assessed each affected patient for DVT risk factors. There were 8 symptomatic DVTs and 2 pulmonary embolisms detected in 327 adult burn patients (2.4% incidence). No DVT patient had the risk factors of morbid obesity, previous DVT, congestive heart failure, or neoplastic disease. One patient was older than 65 years. All of the DVTs occurred in veins draining a burned extremity. Seven of 8 patients had burn wound infections as complications. Burns on the extremity developing the DVT as well as the diagnosis of a burn wound infection were significant risk factors for DVT formation. These findings prompt us to consider routine screening for DVT in burn patients with these risk factors.

Nonaortic mediastinal injuries from blunt chest trauma.

In addition to traumatic aortic injuries (TAI), blunt chest trauma may damage other structures in the mediastinum, including the tracheobronchial tree, the heart and pericardium, and rarely the esophagus. Tracheobronchial injuries may be difficult to separate radiographically from accompanying parenchymal lung injuries. Experience with diagnosis by computed tomography (CT) is still limited. Cardiac injuries often require emergent surgery before extensive imaging can be done. Some patients, usually those with chamber ruptures of the right heart, survive long enough to receive a chest CT, at which time hemopericardium can be detected. Upper esophageal injuries may occur in conjunction with lower cervical or upper thoracic spine injures. Distal esophageal injuries are rarely caused by blunt trauma.

Necrotizing soft tissue infections: a surgical disease.

Despite advances in antibiotics and infection control practices necrotizing fasciitis is still a potentially lethal disease. We reviewed 37 patients with necrotizing fasciitis to identify prognostic factors indicating outcome. Overall mortality was 24 per cent. Mortality was significantly increased for elderly patients. Solid-organ transplant recipients also represented a subset of patients with increased mortality. Most infections were polymicrobial. There was no Clostridium perfringens cultured. Rapid diagnosis and treatment with surgical debridement remains the cornerstone of therapy.

Methylprednisolone inhibits three classes of neutrophil receptors in human blood in vitro.

An analysis of receptor modulation on the neutrophil cell surface is essential for gaining insight into the activation and function of neutrophils in host defense. Moreover, agents that regulate the expression of surface receptors may have profound implications in the management of host response to infection. With this study, we extend previous observations in isolated cells of the putative ability of methylprednisolone sodium succinate (MPSS) to inhibit ligand binding to the formyl peptide receptor. Because neutrophils are exquisitely sensitive to isolation conditions, we have analyzed the regulation of receptor expression using flow cytometry in whole blood. This technique allows discrimination of neutrophils from other formed elements without isolation. Quiescent cells in blood exhibit low levels of formyl peptide receptor, CD11b/CD18, and CD14. We show that MPSS blocks upregulation of each of these receptors in response to three different stimuli (formyl peptide, lipopolysaccharide, and granulocyte macrophage colony-stimulating factor). The inhibition is reversible with an ED50 of approximately 0.4 mg/ml. From these observations, we conclude that the action of MPSS on neutrophils blocks a common response of receptors. Since these receptors probably function in part through independent signaling pathways, MPSS may function at a common site related to vesicular trafficking. Further investigation is needed to determine the specific means by which corticosteroids interfere with neutrophil upregulation mechanisms.

Noninvasive testing of the carotid system.

Noninvasive diagnostic techniques have a high degree of accuracy in identifying hemodynamically significant narrowing of the extracranial carotid artery. Ocular pneumoplethysmography, periorbital Doppler ultrasonography and cerebrovascular thermography focus on the ophthalmic artery and its branches as well as terminal branches of the external carotid artery. Carotid phonoangiography and ultrasonic Doppler arteriography focus directly on the cervical carotid complex.