Controversy exists over the need for cervical spine radiographs in alert, nonintoxicated victims of blunt trauma. We identified 286 patients admitted to a Level II trauma center over a 14-month period who were alert (Glasgow Coma Scale [GCS] greater than 13) and considered at high risk for cervical spine injury by published criteria. All 5 (1.7%) fractures or ligament disruptions occurred in the group with neck pain or tenderness. Of the study group, 141 (49%) were asymptomatic for cervical injury and nonintoxicated (blood alcohol concentration (BAC) less than 100 mg/dL). Mandatory cervical spine radiography in this group would have resulted in an additional cost of $33,699. Routine cervical spine radiography in alert, nonintoxicated asymptomatic victims of blunt trauma is a costly practice that warrants further examination.

Adult↗

PubMedDate not supplied

CT detection of occult pneumothorax in multiple trauma patients.

Chest injuries are the cause of death in 25% of trauma fatalities, and a major contributing factor in an additional 50%. Pneumothorax, the second most common chest injury, may often be initially overlooked. Administration of anesthesia and mechanical ventilation may produce enlargement of a pneumothorax and clinical deterioration. We reviewed 90 trauma patients who had been admitted with a diagnosis of pneumothorax or who had developed pneumothoraces after hospital admission. In 35 cases (38.8%), initial supine chest x-ray study failed to detect a pneumothorax, and the diagnosis was made on CT scan of the chest or abdomen performed within 2 hours of admission. In 15 of these cases (42.8%), identification of the pneumothorax on CT scan resulted in alterations in management, including chest tube placement in 10 patients and intensified monitoring in 5 patients. Failure to identify pneumothoraces in trauma patients may lead to deterioration and significant complications in patients requiring anesthesia or mechanical ventilation. CT scan may facilitate identification in these cases.

Adolescent↗

PubMedDate not supplied

Changes in airborne fungi from the outdoors to indoor air; large HVAC systems in nonproblem buildings in two different climates.

Little is known about the changes in occurrence and distribution of airborne fungi as they are transported in the airstream from the outdoor air through the heating, ventilation, and air conditioning (HVAC) system to the indoor air. To better understand this, airborne fungi were analyzed in the HVAC systems of two large office buildings in different climate zones. Fungal samples were taken in each of the walk-in chambers of the HVAC systems using a six-stage Andersen Sampler with malt extract agar. Results showed that fungal species changed with different locations in the HVAC systems. The outdoor air intake produced the greatest filtration effect for both the counts and species of outdoor air fungi. The colony forming unit (CFU) counts and species diversity was further reduced in the air directly after the filters. The cooling coils also had a substantial filtration effect. However, in room air the CFU counts were double and the mixture of fungal species was different from the air leaving the HVAC system at the supply air outlet in most locations. Diffusion of outdoor air fungi to the indoors did not explain the changes in the mixture of airborne fungi from the outdoor air to the indoor air, and some of the fungi present in the indoor air did not appear to be transported indoors by the HVAC systems.

Air Conditioning↗

PubMedDate not supplied

[Role of intraoperative cholangiography in videolaparoscopic cholecystectomy].

Laparoscopic cholecystectomy represents elective the treatment of symptomatic lithiasis of gallbladder, due to advantages of shorter hospitalization and lower cost. The evolution of technological instruments permits today an easy and rapid execution of intraoperative cholangiography (IC). Therefore the elective or selective application of IC is debated, because of the effective determination of iatrogenic lesions and the real possibility of diagnosis for unknown lithiasis of biliary tract. Some authors agree that anatomic lesions cannot be prevented by IC, because 50% of its occur during the surgical dissection to prepare structures of Calot's triangle to make cholangiography. On the other hand the early diagnosis of iatrogenic lesions is fundamental for the results. The previous biliary symptomatology (jaundice), the elevation of biochemical parameters of biliary function (bilirubinemia, transaminase and alkaline phosphatase) and the dilatation of biliary ducts represents the indication to IC. The examination is also recommended in case of difficulties of dissection due to inflammatory process, to clarify the anatomy with more safety. Finally, the technique is well defined. The choice of patients is made on the basis of surgeon's opinions but we think that a good selection of patient is the only chance to perform IC with the best results.

Cholangiography↗

PubMedDate not supplied

[Differentiated cancer of the thyroid: our experience].

The authors explain their experience about 136 patients affected by differentiated thyroid carcinoma. They compare different surgical procedure (total thyroidectomy vs conservative surgery). Although the surgical significance above the survival is discuss again, the authors, analysing the prognostic factors and the long term results, identify the total thyroidectomy maybe associated to lymphectomy and radioiodine therapy like the best treatment for this pathology.

Adolescent↗