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Biomedical subjects

C F Allen

Publications and source records attributed to C F Allen.

At least 19 recordsLinked to original sources
PubMed2001

Can we improve trauma mortality in a state with a voluntary trauma system.

BACKGROUND: Arizona has no organized statewide trauma system. We looked at the 1997 and the 1998 Uniform Hospital Discharge Data Set (UHDDS) for the State of Arizona, and examined the trauma mortality data at both trauma hospitals and nontrauma hospitals. METHODS: All qualifying mortalities based on hospital data from 1997 through 1998 were reviewed for the State of Arizona. Trauma deaths from 32 nontrauma hospitals were examined and compared with that of 7 level 1 trauma centers within the state. RESULTS: In this time period, there were 375 qualified mortalities from nontrauma centers and 761 qualified mortalities from level 1 trauma facilities. Only 29 (8%) of nontrauma hospital deaths were found to be due to motor vehicle accidents. Only 8 (4%) mortalities at nontrauma centers were due to firearms. CONCLUSION: The data suggest that patients are arriving at the appropriate facility for definitive care despite the absence of a formal statewide trauma system.

Arizona↗
PubMed2000

Management guidelines for hypotensive pelvic fracture patients.

Pelvic fractures are common in blunt trauma patients and are often associated with other system injuries. Most studies describe the type of pelvic fractures and classify them by the forces creating the injury. Mortality from these fractures is due most often to other system injuries or to hemorrhage. Mortality ranges from 5 to 20 per cent depending on complexity and number of systems injured. We studied 692 cases of pelvic fractures and analyzed the seriously ill patients. They were identified by blood pressure (BP) less than 90 systolic on presentation to the trauma room and having a complex pelvic fracture. The management of these patients was by a protocol used by a group of eight trauma surgeons. This group of 75 hypotensive pelvic fracture patients were analyzed to identify significant factors in their management that predicted mortality. Patients with base excess (BE) values < or =-5 were significantly more likely to die (P<0.05). Patients with BP < or =90 on leaving the trauma room had a significantly higher mortality (P<0.01). Injury Severity Score predicted mortality and can be useful as a tool for quality assurance and process improvement. The early operative intervention to fix associated fractures within 24 hours was not detrimental to patient outcome. Overall mortality in this very sick population was 14.7 per cent. Emergent angiography was used successfully on 14 patients. Seven patients died of continued bleeding. The most important management guidelines for these seriously injured, complex patients are: 1) resuscitate with BE used as a monitor; 2) keep patient blood volume as close to normal as possible; 3) use BP, BE, and ISS to evaluate management of these patients.

Adolescent↗
PubMed1997

Community development for health and identity politics.

Community development for health (CD4H) is defined as the mobilization of communities actually or potentially suffering from a health problem to eliminate its causes or alleviate its consequences. This paper links this with questions of social identity, focusing on issues of ethnicity and 'race', in health promotion. When combined with notions of ethnicity and 'race'. CD4H is frequently a reaction to inequalities which are communally experienced and believed to increase risk of ill-health for the group. This paper theorizes the link between communal experience and activity to promote health, by drawing on sociological theory linking structure and agency. It examines how discourses of belonging and exclusion are enacted in struggles for health. Via examples from the Caribbean and the UK, instances of 'identity politics' in CD4H are identified, viewed as the use of essentialist, binary notions of self and other in the attempt to gain an advantage over the other. It is argued that such instances should not be considered in isolation, but should be viewed as responses to experience, particularly, in the UK context, the experience of racism in the Health Service.

Community Health Planning↗
PubMed1994

Pelvic fracture complicated by bilateral ureteral obstruction: case report.

A case of pelvic fracture with pelvic hematoma resulting in bilateral ureteral obstruction and acute renal failure is discussed. Treatment was with bilateral tube nephrostomies, resulting in prompt resolution of renal failure. Urinary tract obstruction is a rare problem associated with pelvic fracture that can be recognized and treated early to minimize morbidity related to obstructive uropathy.

Acute Kidney Injury↗
PubMed1975

Amygdalar participation in tonic ACTH secretion in the rat.

The role of the amygdaloid complexes in the compensatory hypersecretion of ACTH following adrenalectomy was studied in the adult male rat. Unilateral or bilateral radiofrequency or knife-cut lesions were placed in the amygdalae, their efferent pathways or the septal region. Three weeks following adrenalectomy resting plasma ACTH concentrations were measured by radioimmunoassay. Bilateral lesions of a direct medial-projecting portion of the ventral amygdalo-hypothalamic pathway blocked the compensatory hypersecretion of ACTH following adrenalectomy. A unilateral complete amygdalar lesion coupled with destruction of the same direct amygdalo-hypothalamic pathway on the opposite side had the same positive effect. In contrast, unilateral destruction of the direct amygdalo-hypothalamic projections, ablation of the septum, or bilateral destruction of the stria terminalis did not block hypersecretion of ACTH following adrenalectomy. These data suggest that the amygdalae and their direct hypothalamic projections, but not the stria terminalis or septum, are essential for the hypersecretion of ACTH following adrenalectomy. Furthermore, one amygdaloid complex appears sufficient for this effect. It is possible that the amygdalae act as a central nervous system 'glucocorticoid-sensor' in the modulation of ACTH secretion in the rat.

Adrenalectomy↗
PubMed1975

Evidence that the pars intermedia and pars nervosa of the pituitary do not secrete functionally significant quantities of ACTH.

We have compared the capacity to secrete ACTH in response to stress or adrenalectomy in control rats and in those with total hypophysectomy (H), adenohypophysectomy (AH) with preservation of the intermediate and the neural lobes, neurohypophysectomy (NH) with removal of the pars nervosa and all or part of the pars intermedia with preservation of the adenohypophysis, or incomplete adenohypophysectomy (IAH) in which a portion of the adenohypophysis and all of the pars intermedia and pars nervosa were left intact. Plasma ACTH measured with an N-terminal antibody that reacts on an equimolar basis with ACTH and alpha-MSH but not with other known pituitary hormones was elevated after ether or tourniquet stress in all except the H group. Three weeks after adrenalectomy there was an elevated basal plasma ACTH and an augmented ACTH response to stress in intact and IAH but not in AH rats. When a more specific alpha11-24 ACTH antibody was used there was a high plasma ACTH after ether stress in the IAH, NH, and intact groups but not in the AH or H groups. Adrenal weight and plasma corticosterone after tourniquet or ether stress were indistinguishable in the AH and H groups and were much higher and nearly identical in the intact, NH and IAH groups. We conclude that only the adenohypophysis secretes functionally significant amounts of ACTH. Plasma ACTH detected by the N-terminal antibody in the AH group is probably related to alpha-MSH or similar peptides and is incapable of maintaining adrenal weight or stimulating corticosterone secretion.

Adrenal Glands↗
PubMed1975

Nyctohemeral and sex-related variations in plasma thyrotropin, thyroxine and triiodothyronine.

TSH, T4, and T3 were measured by radioimmunoassay in plasma samples obtained from 77 young adult male and 114 female rats fed a Purina high-iodine diet and maintained in an isolated room, 2-4/cage, at 24 +/- 1 C with light from 0600-1800 h. In one experiment, 7 male and 7 female rats were decapitated every 3 h for 30 consecutive h and trunk blood was collected. There was a clear nyctohemeral rhythm of plasma TSH in both sexes characterized by a zenith at 1200 h and a nadir between 1800 and 2100 h. The plasma TSH cycle was approximately 180 degrees out of phase and negatively correlated (P less than .05) with that of plasma corticosterone (B) in both sexes. Although glucocorticoids have been reported to suppress TSH secretion, there was no causal relationship between plasma B and TSH in our experiments since the TSH cycles were normal in chronically adrenalectomized rats. Normal TSH cyclicity was not observed in severely iodine-deficient rats with extremely high plasma TSH levels although the nyctohemeral B rhythm was normal. Plasma TSH was approximately twice as high in males as in females (overall mean +/- SE: M = 149 +/- 11, F = 81 +/- 7 muU/ml, p less than 0.001). There was no significant difference (P greater than 0.05) in plasma TSH at different stages of the estrous cycle. Plasma T4 was slightly, but significantly, higher in males than females (overall mean +/- SE: M = 6.4 +/- 0.1, F = 6.0 +/- 0.1 mug/100 ml; P less than 0.001), while T3 was higher in females than in males (overall mean +/- SE: M = 69.5 +/- 1.7, F = 80.3 +/- 2.1 ng/100 ml; P less than 0.001). No significant nyctohemeral rhythm was observed in plasma T4 or T3 in either sex. These observations indicate that: 1) There is a nyctohemeral rhythm of plasma TSH which is independent of plasma B fluctuations and not associated with proportional changes in plasma thyroid hormones. 2) A sustained high rate of TSH secretion abolishes the normal nyctohemeral plasma TSH rhythm. 3) There are significant differences in plasma concentrations of TSH, T4, and T3 between male and female rats.

Adrenal Glands↗
PubMed1975

Absence of nyctohemeral variation in stress-induced ACTH secretion in the rat.

Changes in plasma ACTH concentrations were measured in the adult male rat following a stressor in order to ascertain if there is a nyctohemeral variation in ACTH secretion following stress. The immuno-reactive ACTH concentrations obtained following a 2.5-min hind-leg tourniquet at 0400 or 1600 hours in pentobarbital-anesthetized animals were compared to those obtained in anesthetized and unanesthetized, unstressed controls. Neither absolute nor increment change in plasma ACTH concentrations following morning or afternoon tourniquet stress were significantly different after either 20 or 40 min anesthesia. Moreover, plasma ACTH concentrations from unstressed, unanesthetized rats showed a slight but significant difference (p smaller than 0.05) at 0400 hours [118 plus or minus 18 pg/ml (mean plus or minus SE)] compared to 1600 hours (64 plus or minus 12 pg/ml) indicating a reversal of the expected ACTH rhythm. Plasma corticosterone concentrations in these same rats showed the predicted lower-morning and higher-afternoon corticosterone pattern suggesting a possible nyctohemeral difference in the adrenal sensitivity to circulating levels of ACTH.

Adrenocorticotropic Hormone↗
PubMed1973

Carotenoid composition of spinach chloroplast grana and stroma lamellae.

Stroma lamellae and grana stacks prepared by French press rupture of spinach (Spinacia oleracea) chloroplasts contain similar amounts of beta-carotene on a protein basis. The grana fraction has considerably more xanthophylls than does the stroma fraction. Total carotenoid to chlorophyll ratios are similar for both fractions.

Journal Article↗