Pesticides As Pollutants Under The Clean Water Act

Climate change and shifting weather patterns affect the development and distribution of insects and other pests. Public agencies as well as private parties, such as farmers and ranchers, commonly use chemical and biological pesticides to combat the spread and entrenchment of these nuisances. Given the ubiquitous use of pesticides, it is not surprising that pesticide regulation involves important issues of law and public policy

Pädiatrisches stumpfes thorakoabdominales Trauma: Damage-Control-Resuscitation-Therapie

Zusammenfassung: Die Primärversorgung von Kindern mit schwerem stumpfem Bauchtrauma und begleitender Azidose, Koagulopathie und Hypothermie (letale Trias) erfordert ein effizientes multidisziplinäres Therapieregime zur Reduktion der Mortalität. Ein 5,5Jahre alter Junge wurde auf einem Bergbauernhof zwischen Traktorhinterrad und Hoftorumrandung im Torsobereich eingequetscht. Es kam zu einer Milzruptur Grad IV, einer Leberruptur Grad III, einer Pankreaslazeration Grad III, einer beidseitigen Lungenkontusion und einem begleitenden Weichteiltrauma mit Rhabdomyolyse. Aufgrund des schweren Traumas mit Auftreten einer Koagulopathie und einer kombinierten metabolisch-respiratorischen Azidose erfolgten die Gabe von Blutprodukten anstelle der von Kristalloiden, Akzeptanz einer permissiven Hypotension, Stabilisierung der Körpertemperatur im Sinne einer Damage-Control-Resuscitation-Strategie sowie eine Milz erhaltende operative Versorgung mittels Laparotomie. Es wird ein mögliches Therapieregime für das pädiatrische schwere Trauma mit Massentransfusion (MT) diskutier

The Prevalence and Clinical Correlates of an Auscultatory Gap in Systemic Sclerosis Patients

Introduction. Accurate blood pressure (BP) measurement is essential to the diagnosis and management of hypertension in patients with systemic sclerosis (SSc) to help prevent renal and cardiovascular complications. The presence of an auscultatory gap during manual BP measurement—the temporary disappearance of the Korotkoff sounds during cuff deflation—leads to a potentially important underestimate of systolic BP if undetected. Objectives. Since the presence of an auscultatory gap is frequently associated with increased vascular stiffness, we investigated its presence and correlates in 50 consecutive SSc patients. Methods. For each patient, BP was measured sequentially using three different approaches performed in the same order. Results. Sixteen of 50 patients (32%) had an auscultatory gap which if undetected would have resulted in clinically important underestimates of systolic BP in 4 patients. The presence of an auscultatory gap was statistically associated with the presence of antibodies to RNA polymerase III (P<0.0068) and SSc diagnosis type (P<0.01). Conclusions. Our study demonstrates that auscultatory gaps are relatively common in SSc and correlate with markers for SSc vasculopathy. If undetected auscultatory gaps may result in clinically important underestimation of BP. Thus, electronic oscillometric BP may be preferred in SSc patients