The deadly dozen of chest trauma

No Abstract

Analysis of B lymphocyte function in prospective renal transplant patients

It is well established that uraemia impairs the in vivo cell-mediated immune responses while the in vitro lymphocyte responses of patients on maintenance dialysis have been reported to be impaired or normal . The work in this thesis deals predominantly with production of immunoglobulin in vitro by peripheral blood mononuclear cells obtained From normal and uraemic subjects. The protein A plaque Forming cell assay was utilised to enumerate immunoglobulin secreting cells and several parameters affecting its performance were examined. Thus, it was Found that plaque Forming cell numbers were dependent on the concentrations of sheep red blood cells, anti-serum, DEAE-dextran and complement while PEG 6000 was shown to improve the quality of the plaques. The optimal conditions For storing the cells before plating and incubating them after plating were also established and in addition, it was shown that cryopreservation does not affect plaque Forming cel1 activity. The optimal conditions For both proliferation and immunoglobulin production in response to mitogenic stimulation were also examined and once again the suitability of cryopreserved peripheral blood mononuclears For use in mitogen-stimulated cultures was confirmed, A normal range For both spontaneous and mitogen induced plaque Farming cells was established and it was shown that pokeweed mitogen(PWM) was the most effective polyclonal B cell activator in inducing plaque Forming cells while Epstein-Barr-Virus(EBU) induced similar IgM-PFC as PWM. Co-stimulation of control peripheral blood mononuclear cells with Concavalin A(ConA) showed that both PWM and Staphylococcus Aureus Cowan I(SAC) cultures were suppressed although the Former proved to be much more sensitive. Steroids are known to inhibit suppressor T cells and when methyl-prednisolone was added in PWM and SAC cultures of control peripheral blood mononuclear cells, PWM induced production of immunoglobulin was more readily enhanced. I propose that these polyclonal B cell activators differ in their susceptibility to regulation by suppressor T cells. When indomethacin was added in the cultures to inhibit prostaglandin synthesis, it was observed that SAC responses were slighty but non-significantly enhanced. Uraemia was not Found to have a significant effect on the number or proportion of lymphocyte populations but . it impaired the proliferative' responses to PHA and PUIM. However, the relative in vitro immunosuppressive effect of steroids was not Found to be stronger in these cultures. EBU and PWM induced plaque Formation was normal in uraemic patients while both spontaneous and SAC induced immunoglobulin production were reduced. In addition, the combination of PWM and SAC did not produce the synergistic effect Found in control cultures. Pre-incubation of control cells with uraemic serum affected the quality and suppressed slightly the numbers of PWM-induced plaque Forming cells. Addition of methyl-prednisolone to SAC cultures did not produce the enhancing effect Found in controls indicating that the reduced SAC responses in uraemia were not caused by incraasad supprassar T cell activity. Howevar, the SAC responses of uraemic peripheral blood mononuclear cells seemed to benefit more by the addition of indomethacin than the SAC responses of control cells. My results indicate strongly that the reduced production of immunaglobulin in uraemia is not due to reduced numbers of lymphocytes but reflects a true functional abnormality and the observed reduced proliferative responses of uraemic peripheral blood mononuclears to T cell mitogens indicate that T lymphocyte function is impaired. The studies using polyclonal B cell activators suggested that B cell function and T-B cell co-operation remained intact in uraemic patients and indicated that the defective immunoglobulin responses in both the spontaneous and SAC system were due to a functional abnormality of the helper T cell

A heuristic approach and heretic view on the technical issues and pitfalls in the management of penetrating abdominal injuries

There is a general decline in penetrating abdominal trauma throughout the western world. As a result of that, there is a significant loss of expertise in dealing with this type of injury particularly when the patient presents to theatre with physiological instability. A significant percentage of these patients will not be operated by a trauma surgeon but, by the "occasional trauma surgeon", who is usually trained as a general surgeon. Most general surgeons have a general knowledge of operating penetrating trauma, knowledge originating from their training years and possibly enhanced by reading operative surgery textbooks. Unfortunately, the details included in most of these books are not extensive enough to provide them with enough armamentaria to tackle the difficult case. In this scenario, their operative dexterity and knowledge cannot be compared to that of their trauma surgeon colleagues, something that is taken for granted in the trauma textbooks. Techniques that are considered basic and easy by the trauma surgeons can be unfamiliar and difficult to general surgeons

The Association between TGF-β1 G915C (Arg25Pro) Polymorphism and the Development of Primary Open Angle Glaucoma: A Case-Control Study

The purpose of the current study was to identify the potential association between Single Nucleotide Polymorphism (SNP) TGFβ1 +915 (C or G) in codon 25 and Primary Open Angle Glaucoma (POAG). Overall, 88 cases with POAG and a control group of 52 healthy individuals were recruited from the First Ophthalmology Department of Athens University. DNA was isolated from whole blood samples and genotype frequencies for the polymorphism rs1800471 (G915C, Arg25Pro) of the TGF-β1 gene were assessed. Genotype distribution frequencies for the polymorphism rs1800471 (G915C, Arg25Pro) of the TGF-β1 gene were not statistically different between patients with POAG and control subjects. The present study failed to determine any significant genotypic association with POAG, despite the fact that the presence of the C allele was scarcely increased in the POAG when compared with the control group

ATP-binding cassette transporter A1 gene polymorphisms and serum lipid levels in young Greek nurses

<p>Abstract</p> <p>Objective</p> <p>The ATP-binding cassette transporter A1 (ABCA1) is essential protein involved in lipid metabolism. The present study was undertaken to detect the possible association of polymorphisms in the ABCA1 gene [rs2230806 (R219K) and rs2230808 (R1587K)] and lipid profile in Greek young nurses.</p> <p>Methods</p> <p>The study population consisted of 308 unrelated nurses who were genotyped and the ABCA1 polymorphisms were detected. Additionally, lipid profile [total cholesterol (TC), triglycerides (TGs), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and apolipoprotein (apo) A] was evaluated.</p> <p>Results</p> <p>There was no difference in the genotypic and allelic frequencies of the R219K polymorphism according to lipid profile. The R1587K genotypes differed significantly according to TC, LDL-C and TGs concentration (p = 0.023, p = 0.014 and p = 0.047, respectively). Particularly, significant difference in TC, LDL-C and TGs concentration was detected between RK and RR genotypes (p = 0.006, p = 0.004, p = 0.014, respectively). Women with RK genotype compared to RR genotype had higher concentration of TGs (134.25 mg/dl vs 108.89 mg/dl, p = 0.014, respectively), total cholesterol (207.41 mg/dl vs 187.69 mg/dl, p = 0.006, respectively), and LDL-C (110.6 mg/dl vs 96.9 mg/dl, p = 0.004, respectively).</p> <p>Conclusions</p> <p>These findings suggest that the R1587K polymorphism of ABCA1 gene was associated with lipid profile of Greek nurses. Women with RK genotype had higher TGs, total and LDL-C concentration compared to RR genotype. These observations may be significant in assessing the risk of CAD since a 1% change in LDL-C is associated with a 1% change of cardiovascular events. Also, TGs concentration were documented to play a significant role in women. However, this needs to be confirmed by larger studies.</p

Sex-associated effect of CETP and LPL polymorphisms on postprandial lipids in familial hypercholesterolaemia

Background: This study assessed the gender-specific influence of the cholesteryl ester transfer protein (TaqIB, I405V) and lipoprotein lipase (S447X) polymorphisms on the response to an oral fat tolerance test in heterozygotes for familial hypercholesterolaemia.Methods: We selected and genotyped 80 men and postmenopausal women heterozygous for familial hypercholesterolaemia (main group) as well as 11 healthy control subjects. Patients were subgrouped based on their response to oral fat tolerance test. The oral fat tolerance test was defined as pathological when postprandial triglyceride concentration was higher than the highest triglyceride concentration observed in healthy subjects (220 mg/dl) at any time (2, 4, 6 or 8 h).Results: In the pathological subgroup, men had significantly higher incremental area under the curve after oral fat tolerance test than postmenopausal women. Furthermore, multivariate analysis revealed a gender association of TaqIB and I405V influence on postprandial lipaemia in this subgroup.Conclusion: In conclusion, it seems that gender and TaqIB polymorphism of the cholesteryl ester transfer protein gene were both associated with the distribution of triglyceride values after oral fat tolerance test, only in subjects with a pathological response to oral fat tolerance test. Specifically, men carrying the B2 allele of the TaqIB polymorphism showed a higher postprandial triglyceride peak and a delayed return to basal values compared with women carrying B2. However, further investigations in larger populations are required to replicate and confirm these findings

Prognostic Determinants in Patients with Traumatic Pancreatic Injuries

The aim of this study was to identify factors that predict morbidity and mortality in patients with traumatic pancreatic injuries. A retrospective review was performed on 75 consecutive patients with traumatic pancreatic injuries admitted to the Emergency Medical Center at Masan Samsung Hospital and subsequently underwent laparotomy during the period January 2000 to December 2005. Overall mortality and morbidity rates were 13.3% and 49.3%, respectively. A multivariate regression analysis revealed that greater than 12 blood transfusions and an initial base deficit of less than -11 mM/L were the most important predictors of mortality (p<0.05). On the other hand, the most important predictors of morbidity were surgical complexity and an initial base deficit of less than -5.8 mM/L (p<0.01). These data suggests that early efforts to prevent shock and rapidly control of bleeding are most likely to improve the outcome in patients with traumatic pancreatic injuries. The severity of pancreatic injury per se influenced only morbidity

Injury patterns and emergency department mortality after unsuccessful suicide : a descriptive study of a consecutive case series

We hypothesized that trauma bay management and 24-hour emergency department (ED) mortality of patients that survived unsuccessful suicide attempts differ from other patients. Severely injured patients after an unsuccessful suicide attempt can be admitted to resuscitation rooms of any ED. To our knowledge, 24-hour mortality has not been investigated yet. We studied such patients admitted to the resuscitation room of a large ED. This consecutive case series included 64 patients who were evaluated in the resuscitation room because of an unsuccessful suicide attempt. Patient variables were recorded including method of suicide attempt, injuries, hemodynamic status, and treatment. Most patients were male [57 patients (89%)], and the most frequent methods were ingestion of harmful devices or substances [15 patients (23%)]; hanging [9 patients (14%)]; and strangulation [9 patients (14%)]. There were 2 patients who died in the ED: 1 from a self-inflicted gunshot to the head and the other from self-inflicted herbal poisoning. The frequency of emergency airway intervention was greater in patients after unsuccessful attempted suicide [18 patients, 28% (95% confidence interval [CI], 17.2%, 39%; endotracheal intubation, 17 patients; emergency tracheotomy, 1 patient] than all ED patients [1458 patients (16%); (95% CI, 14.9%, 16.4%; P = 0.005)]. Following attempted survived suicide, 24-hour ED mortality was 3% and 4% within the control group; the difference is insignificant (P = 0.9596). However, ED mortality showed a trend toward earlier death within the suicidal group. Resuscitation room mortality of patients that survived unsuccessful suicide does not differ from the general population of an ED resuscitation room