Geospatial mapping can be used to identify geographic areas and social factors associated with intentional injury as targets for prevention efforts distinct to a given community.

BACKGROUND: Geographic information systems (GIS) have proven effective in studying intentional injury in various communities; however, GIS is not implemented widely for use by Level I trauma centers in understanding patient populations. Our study of intentional injury combines the capabilities of GIS with a Level I trauma center registry to determine the spatial distribution of victims and correlated socioeconomic factors. METHODS: One thousand ninety-nine of 3,109 total incidents of intentional trauma in the trauma registry from 2005 to 2015 had sufficient street address information to be mapped in GIS. Comparison of these data, coupled with demographic data at the block group level, determined if any clustering or spatial patterns existed. Geographic information systems delivered these comparisons using several spatial statistics including kernel density, ordinary least squares test, and Moran's index. RESULTS: Kernel density analysis identified four major areas with significant clustering of incidents. The Moran's I value was 0.0318. Clustering exhibited a positive z-score and significant p value (p < 0.01). Examination of socioeconomic factors by spatial correlation with the distribution of intentional injury incidents identified three significant factors: unemployment, single-parent households, and lack of a high school degree. Tested factors did not exhibit substantial redundancy (variance inflation factor < 7.5). Nonsignificant tested factors included race, proximity to liquor stores and bars, median household income, per capita income, rate with public assistance, and population density. CONCLUSION: Spatial representation of trauma registry data using GIS effectively identifies high-risk areas for intentional injury. Analysis of local socioeconomic data identifies factors unique to those high-risk areas in the observed community. Implications of this study may include the routine use of GIS by Level I trauma centers in assessing intentional injury in a given community, the use of that data to guide the development of trauma prevention, and the assessment of other mechanisms of trauma using GIS. LEVEL OF EVIDENCE: Epidemiological, level IV.

Open resection for subvalvular aortic stenosis in dogs.

OBJECTIVE: To describe the surgical technique for open resection of congenital subvalvular aortic stenosis in dogs and to determine outcome of dogs undergoing the procedure. DESIGN: Uncontrolled clinical trial. ANIMALS: 17 dogs with congenital discrete subvalvular aortic stenosis. PROCEDURE: Dogs were placed on cardiopulmonary bypass by catheterizing the femoral artery and both vena cavae. The aorta was cross clamped, and cold cardioplegia solution was administered. The aortic root then was opened with a curvilinear incision. A subvalvular discrete fibrous ring was resected in all dogs. Septal myectomy was performed simultaneously on 11 dogs. RESULTS: 15 of 17 dogs survived the operation and were discharged from the hospital. Mean +/- SD maximal instantaneous aortic systolic pressure gradient measured by means of Doppler echocardiography was significantly reduced from 119 +/- 42 mm of Hg before surgery to 41 +/- 10 mm of Hg 12 months after surgery. Despite substantial reduction in the systolic pressure gradient, 4 of 15 dogs died suddenly between 7 days and 30 months after surgery. Three of the 4 dogs that died suddenly had pressure gradients > or = 180 mm of Hg and ventricular tachycardia before surgery. Eleven dogs were still alive between 1 and 48 months after surgery. CLINICAL IMPLICATIONS: The procedure resulted in substantial reductions in systolic pressure gradients in dogs with severe congenital subvalvular aortic stenosis. However, some dogs with severe aortic stenosis died suddenly after surgery. Thus, this surgery should not be considered curative. Proof of a survival benefit in dogs undergoing this surgery will have to await longer term follow-up.

Dynamic cardiomyoplasty for treatment of idiopathic dilatative cardiomyopathy in a dog.

In a dog with advanced dilatative cardiomyopathy, dynamic cardiomyoplasty resulted in improvement in clinical status and systolic function. Dynamic cardiomyoplasty involved surgical isolation of the right latissimus dorsi muscle on its neurovascular pedicle, transposition of the muscle into the thoracic cavity, wrapping the ventricles with the muscle, and implantation of a myostimulator for cardiosynchronous stimulation of the muscle. After a 2-week period, the latissimus muscle underwent a 50-day period of progressive burst stimulation to transform the muscle to a fatigue resistant phenotype. Thereafter, the muscle received cardiosynchronous stimulation at a 3:1 R-wave-to-burst ratio. This procedure may offer hope for long-term treatment of dilatative cardiomyopathy in dogs.

Presumed Kawasaki disease resulting in multiple coronary artery aneurysms in an adult.

Kawasaki disease (mucocutaneous lymph node syndrome) is a pathological process seen mostly in children, but has been reported in adults. The late manifestations of the syndrome can include the development of multiple coronary artery aneurysms. This article describes a 27-year-old man with no risk factors for atherosclerotic disease with multiple coronary artery aneurysms.