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[en] To report our experience of managing extensive retroperitoneal hematoma (RH) in patients with blunt trauma and to determine any associated factors affecting causation and mortality. In this retrospective observational study, patients diagnosed with extensive RH following blunt trauma admitted to King Saud Medical Complex, Riyadh, Kingdom of Saudi Arabia between January 2004 and December 2009 were included. Patient data were explored for injury severity score (ISS), associated injuries, location of hematoma, amount of blood transfusions, coagulation profile, operative management, hospital stay, and mortality. The outcomes in surviving and non-surviving patients were compared. Out of 290 patients presenting with RH, extensive RH was found in 46 patients (15.8%). The overall mortality was 32.6%. The pelvis was the most frequent location of RH in combination with lateral and central zones (65.2%). The lower extremity and pelvic fractures were the most common injury. Associated intra-peritoneal injuries were present in 39.1% patients. An exploratory laparotomy was performed in 58.7% patients (n=27). A high ISS (55.9 versus 35.5, p<0.0001), abnormal coagulation profile (odds ratio [OR] 7.8, 95% confidence interval [CI] 1.974-30.932, p=0.005, and associated chest injuries OR 5.94, 95% CI 1.528-23.19, p=0.014) were independent factors associated with mortality. Multiple musculoskeletal injuries in addition to intra-abdominal injuries and abnormal coagulation are major factors associated with the presence of extensive RH. High ISS, abnormal coagulation, and associated chest injuries are independent factors associated with mortality (Author).
[en] Between 2002 and 2003, an outbreak of a trout's mass death occurred at the intensive fish culture a Peruvian rural town (Marcara, Huaraz, Peru) where 15,000 from 20,000 fish died. Our objective in the present study was to investigate the high mortality of the trout biomass occurred in period of two months. This study was conducted after the peak of the outbreak has occurred. We collected samples of fishes, water and fish foodstuff which were examined for aflatoxin, metals, toxics and bacteria. We interviewed people who administered the feed pellet. Feed sample preparation, transport and storage. The processing of fish feed was at room temperature which was below 16 deg C. Once prepared the diet it was keep under an appropriate room for a few days before sending to Marcara town. Fishes. 20,000 immature trout larval of rainbow trout (Oncorhynchus mykiss) was acquired from an official Peruvian fish culture. The fishes were fed twice a day. Adjusted of feed ration was based from the monthly sample weight. Pellet sample analysis. The samples were analyzed for aflatoxin Bl (AFB1) according to the method previously published. The sensitivity is 0.1 μg per 1 kg of sample. During the fish development until the peak of the outbreak, the foodstuff to fishes was maintained in plastic bags. At this time the storage room temperature was 18-20 deg. C between 1.00-2.00 P.M. and the humidity rose close to 90 % at the Marcara facilities. Mortality development and Effect on survival. The fishes maintained in 4 pods had a normal surviving until end of November, less than 10 specimen dead by month. The fish outbreaks started the first week of December and continuing until the fourth week of January totalizing 15,000 dead fish from 20,000. The survival of the fish at the first month was less than 50 %. The mortality continues throughout January totalizing 15,000 dead fish and leaving only 25% survival. Laboratory data. The collected samples for analysis were frozen and transported in dry ice to the analysis laboratory. We took the samples on January 23 and it was analyzed on January 25. Aflatoxin Bl was detected in three samples of fish muscle and in the 3 samples of fish feed but it was negative in the 3 water samples. The AFB1 concentration was 10 times in the fish feed than in the fish muscle. In spite of heavy metal residues (lead, mercury and arsenic) were found in the fish samples, those concentrations were below the permissible levels. Volatile toxic residues were negative in water, fish and feed. Only the fish feed samples were contaminated by bacteria (Staphylococcus aureaus). Under favourable conditions of temperature and humidity, the Aspergillus flavus grows on certain foods and feeds, resulting in the production of aflatoxin Bl. For the trout, the highest admissible amount of AFBI in feed is 0.1 μg per kg. The data showed suggest that an improper handling of fish foodstuff (18-20 deg. C and 90 % humidity) was the cause growing of mould and/or spores and consequently it produced an increased concentration of AFBI in fish feed. Liver is strategically located between intestinal tract and general circulation. As AFBI concentration ranged in liver between 10 and 100 ppb, this level is capable to produce an acute hepatotoxicity in the fish stocks. (author)
[en] Ruptured abdominal aortic aneurysm is related with a 100% mortality rate if left untreated. Even with surgical intervention or endovascular repair, mortality is still extremely high. However, there are conditions in which neither open surgical aneurysm repair nor endovascular aneurysm repair can be considered a viable therapeutic option because of comorbidities or anatomic reasons. We report a case of successful endovascular treatment in a patient with ruptured abdominal aortic aneurysm by occluding the abdominal aneurysm using the Amplatzer Vascular Plug (AVP II).
[en] Data on the management of carcinoma of the prostate by radiation therapy were obtained from 12 centres in Canada. The outcome in a total of 1496 patients has been analysed as a medical audit. The crude five-year survival is 69 percent and at eight years it is 51 percent
[en] The purpose of this research is study of frequency dynamics and infants's mortality depending on congenital disease of development in the Semipalatinsk region during 1982-1995. The predominance of congenital disease of developments: - of central nervous system, - of cardiovascular system;, - of digestion organs were discovered
[en] This paper provides the estimate of cancer mortality caused by high-level radiation exposure. The method to estimate it is life table method. Throughout this method, we can obtain the lifetime and age-conditional probability of developing or dying of cancer. Moreover we can see the loss of rest of life. We obtain the result that the excess cancer mortality risk is not so serious. (author)
[en] Objective: to analyze the technique success rate of endovascular stent-graft therapy in treating type B aortic dissection and to discuss the occurrence of both mild and severe complications including stroke, paraplegia, etc. Methods: The medical documents concerning endovascular stent-graft therapy for type B aortic dissection published from 1999 to 2009 were searched for through Medline. A total of 12 academic papers with 761 cases were collected. After making inclusion and exclusion criteria, the data obtained from the literature analyzed. Results: The analysis of all the available data showed that the technical success rate of endovascular stent-graft therapy for type B aortic dissection was 97.66%. The occurrence of minor complications, sever complications, stroke and paraplegia was 17.44%, 4.02%, 1.29% and 1.30%, respectively. The mortality was 3.55% within 30 days, and it was 4.08% during follow-up period (ranging from 12 months to 48.3 months). The occurrence of aortic rupture or retrograde aortic dissection formation in follow-up period was 3.06%. Conclusion: Endovascular stent-graft therapy for type B aortic dissection is technically feasible with fewer complications, nowadays it becomes the treatment of first choice. Nevertheless, as the follow-up time is rather short and the randomly controlled studies are lack, whether or not this technique carries statistically significant difference in therapeutic results when compared to other treatments needs to be further studied. (authors)
[en] Aim: To describe the initial pilot phase of the 2009 Scottish Audit of Surgical Mortality (SASM), which includes outcomes and difficulties that arose during any interventional radiology (IR) procedure performed on patients in this audit over an 18 month period. Materials and methods: Approximately 40 consultant interventional radiologists from all units in Scotland elected to participate in the audit. Each response was then peer reviewed after anonymisation of the patient and institution. If a relevant ACON (area for consideration or area of concern) was generated, this was checked by one of the other reviewers before communication with the original reporting radiologist and colleagues. There was then a right of reply by the reporting unit before formal documentation was sent out. Results: Initial results were analysed after 18 months period, during which time 95 forms relating to deaths of surgical inpatients were sent to interventional radiologists identified as having been involved in an IR procedure at some time during the patient’s admission. Seventy-one forms had been returned by July 2010, of which 46 had gone through the entire SASM process. From these, 10 ACONs were attributed. Anonymised case vignettes and reports from these were used as educational tools. Conclusion: Involvement with SASM is a useful process. Significant safety issues and learning points were identified in the pilot. The majority of ACONs identified by the audit were in patients who had undergone percutaneous biliary interventions