Anatomical Criteria (anatomical + criterion)

Distribution by Scientific Domains


Selected Abstracts


Overtriage in trauma , what are the causes?

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2007
O. Uleberg
Background:, Different criteria are employed to activate trauma teams. Because of a growing concern about overtriage, the objective of this study was to investigate the performance of our trauma team's activation protocol. Methods:, Injured patients with trauma team activation (TTA), admission to an intensive care unit or surgical intermediate care unit with a trauma diagnosis, or trauma-related death in the emergency department were investigated retrospectively from 1 January 2004 to 31 December 2005. Different TTA criteria were analysed with respect to sensitivity, positive predictive value (PPV) and overtriage (1 , PPV). Results:, Eight hundred and nine patients were included, 185 (23%) of whom had an Injury Severity Score (ISS) of more than 15. The performance of our protocol showed a sensitivity of 87%, PPV of 22% and overtriage of 78%. The mechanism of injury as a TTA criterion had a sensitivity of 14%, PPV of 7% and overtriage of 93%. Physiological/anatomical criteria and interfacility transfer showed higher PPV and less overtriage. Undertriage (no TTA despite ISS > 15) was identified in 23 patients (13%), 18 of whom were hospital transfers. Conclusion:, A TTA protocol based on physiological, anatomical and interfacility transfer criteria seems to yield a higher precision than, in particular, that based on mechanism of injury criteria. Because of substantial overtriage in our hospital, the TTA protocol needs to be re-evaluated. [source]


Classification of liver and pancreatic trauma

HPB, Issue 1 2006
GABRIEL C. ONISCU
Abstract The liver is the most frequently injured intra-abdominal organ and associated injury to other organs increases the risk of complications and death. This has highlighted the critical need for an accurate classification system as a basis for the clinical decision-making process. Several classification systems have been proposed in an attempt to incorporate the aetiology, anatomy and extent of injury and correlate it with subsequent clinical management and outcome. The widely accepted Organ Injury Scale is based on anatomical criteria that quantify the disruption of the liver parenchyma and defines six groups which may influence management strategies and relate to outcome. The less common pancreatic injury remains a major source of morbidity and mortality due to the likelihood of associated solid or hollow-organ injuries. The implication of a delay in diagnosis and management emphasizes the need for an accurate classification system. The Organ Injury Scale is widely used for pancreas trauma and recognizes the importance of progressive parenchymal injury and in particular ductal injury. Advances in imaging techniques have led to the development of newer radiological classification systems; however, validation of their accuracy remains to be proven. An accurate classification of liver and pancreatic trauma is fundamental for the development of treatment protocols in which clinical decisions are based on the severity of injury. [source]


The effect of irrigation time, root morphology and dentine thickness on tooth surface strain when using 5% sodium hypochlorite and 17% EDTA

INTERNATIONAL ENDODONTIC JOURNAL, Issue 3 2010
O. E. Sobhani
Sobhani OE, Gulabivala K, Knowles JC, Ng Y-L. The effect of irrigation time, root morphology and dentine thickness on tooth surface strain when using 5% sodium hypochlorite and 17% EDTA. International Endodontic Journal, 43, 190,199, 2010. Abstract Aim, To evaluate the effect of irrigation with 5% sodium hypochlorite (NaOCl) alone and in conjunction with 17% ethylenediaminetetraacetic acid (EDTA) on tooth surface strain (TSS) and to analyse the influence of irrigation time, root morphology and dentine thickness. Methodology, Thirty-six single-rooted pre-molars with single canals had their crown and enamel reduced and root canals prepared using a standardized protocol. Teeth were grouped according to anatomical criteria and randomly distributed to experimental irrigation groups: (A) saline (negative control); (B) 5% NaOCl (positive control); (C) 5% NaOCl alternated with 17% EDTA. TSS was measured using electrical strain gauges bonded to the cervico-proximal part of the tooth. Teeth, mounted in clear acrylic resin placed in a universal testing machine, were subjected to nine consecutive 10-min irrigation periods followed by non-destructive occlusal loading to record TSS. Statistical analysis was carried out using two-way hierarchical anova and post hoc multiple comparisons. Results, Two groups showed an increase in TSS from the baseline (initial 10-min irrigation with saline). Group A showed a negligible reduction of 1.2% (343,339 ,,), which was not statistically significant (P = 0.7). Group B showed a highly significant (P = 0.001) increase in TSS by 53.7% (178,253 ,,), and group C showed a significant (P = 0.02) increase in TSS by 17.4% (163,192 ,,). The rate of change in TSS was significantly different between test groups. The length of the tooth (P = 0.04) as well as the mesio-distal (P = 0.05) width had significant effects on TSS. Conclusions, Irrigation with 5% with or without 17% EDTA increased TSS. The increase was significantly greater with 5% NaOCl alone than with 5% NaOCl alternated with 17% EDTA in contrast to previous findings with longer duration of irrigant exposure. Tooth length and mesio-distal root width significantly contributed to the increase in TSS. [source]


Evaluation of pre-hospital trauma triage criteria: a prospective study at a Danish level I trauma centre

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2007
S. H. Kann
Background:, The aim of the present study was to evaluate the precision of our trauma triage protocol [based on the American College of Surgeons, Committee on Trauma (ACS COT)] in identifying severely injured defined as an injury severity score (ISS) > 15. Our hypothesis was that isolated mechanism-of-injury criteria were responsible for a significant over-triage leading to over-use of our trauma team. Methods:, Design: A prospective cohort study. Setting: A level I trauma centre, Aarhus, Denmark. Patients and participants: Among all injured patients admitted during a 6-month period in 2003 we identified severely injured. During the study period, trauma team activations were consecutively registered and triage criteria were prospectively collected. Sensitivity, specificity, positive predictive value, over-triage and under-triage were calculated. Results:, Out of 15,162 patients in the emergency department, 848 injured patients were included and 59 (7%) were severely injured. We had 242 trauma team activations with 54 (22%) severely injured. Sensitivity was 92%, specificity 76%, giving an over-triage of 24% and an under-triage of 8%. The positive predictive value was 22%. Among 60 patients with mechanism-of-injury as the only criterion, five were severely injured in contrast to 12 out of 20 patients with mechanism-of-injury combined with physiological and/or anatomical criteria. Conclusion:, The positive predictive value of our triage protocol was low, only 22%. This was mainly as a result of a significant over-triage from isolated mechanism-of-injury criteria. We recommend revision of the triage protocol and reallocation of our trauma team resources. [source]


Redefining the boundaries of the hippocampal CA2 subfield in the mouse using gene expression and 3-dimensional reconstruction

THE JOURNAL OF COMPARATIVE NEUROLOGY, Issue 1 2005
Edward S. Lein
Abstract The morphology of neurons in the main divisions of the hippocampal complex allow the easy identification of granule cells in the dentate gyrus and pyramidal cells in the CA1 and CA3 regions of Ammon's horn. However, neurons in the CA2 subfield have been much more difficult to reliably identify. We have recently identified a set of genes whose expression is restricted to either the dentate gyrus, CA1, CA2, or CA3. Here we show that these genes have an essentially nonoverlapping distribution throughout the entire septotemporal extent of the hippocampus. 3-Dimensional reconstruction of serial sections processed for in situ hybridization of mannosidase 1, alpha (CA1), bcl-2-related ovarian killer protein (CA3), and Purkinje cell protein 4 (dentate gyrus + CA2) was used to define the boundaries of each subregion throughout the entire hippocampus. The boundaries observed for these three genes are recapitulated across a much larger set of genes similarly enriched in specific hippocampal subregions. The extent of CA2 defined on the basis of gene expression is somewhat larger than that previously described on the basis of structural anatomical criteria, particularly at the rostral pole of the hippocampus. These results indicate that, at least at the molecular level, there are robust, consistent genetic boundaries between hippocampal subregions CA1, CA2, CA3, and the dentate gyrus, allowing a redefinition of their boundaries in order to facilitate functional studies of different neuronal subtypes in the hippocampus. J. Comp. Neurol. 485:1,10, 2005. © 2005 Wiley-Liss, Inc. [source]