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Traumatic
Terms modified by Traumatic Selected AbstractsSECONDARY TRAUMATIC STRESS, PSYCHOLOGICAL DISTRESS, SHARING OF TRAUMATIC REMINISCES, AND MARITAL QUALITY AMONG SPOUSES OF HOLOCAUST CHILD SURVIVORSJOURNAL OF MARITAL AND FAMILY THERAPY, Issue 4 2001Rachel Lev-Wiesel In this study, we examined the issue of secondary traumatic stress (STS) among spouses of Holocaust survivors who were children during the World War II. STS is defined as comprising the same components as posttraumatic stress disorder (PTSD), except that the person evidencing the symptoms has not actually been exposed to the traumatic event(s), but has developed them as a result of caring for someone with PTSD. Participants were 90 couples who completed self-report questionnaires regarding posttraumatic symptoms, psychological distress, and marital quality. The results showed that about one-third of the spouses suffered from some degree of STS symptoms. Secondary traumatic stress symptoms and psychological distress among spouses were significantly related to hostility, anger, paranoia, and interpersonal sensitivity in the survivor, but unrelated to whether the survivor had shared his/her reminiscences with the spouse. Female spouses were found to suffer more distress than male spouses, especially when their partner suffered high levels of PTSD. The results suggest that STS is, to a large degree, related to the demands of living with a symptomatic survivor, possibly more than to the empathic element thought to be central to this syndrome. [source] Utility of an Initial D-dimer Assay in Screening for Traumatic or Spontaneous Intracranial HemorrhageACADEMIC EMERGENCY MEDICINE, Issue 9 2001Mark E. Hoffmann MD Abstract Objective: To evaluate the sensitivity of a D-dimer assay as a screening tool for possible traumatic or spontaneous intracranial hemorrhage. If adequately sensitive, the D-dimer assay may potentially permit omission of a more expensive computed tomography (CT) scan of the head when such hemorrhage is clinically suspected. Methods: Prospective, consecutive, blinded study of patients (age > 16 years) requiring a CT scan of the head for suspected intracranial hemorrhage over a five-month period at a university, Level I trauma center. All study patients had a serum D-dimer assay obtained prior to their CT scans. Sensitivity and specificity, with 95% confidence intervals (95% CIs), of the enzyme-linked immunosorbent assay (ELISA) D-dimer assay for the detection of intracranial hemorrhage were calculated. Results: Of the 319 patients entered in the study, 25 (7.8%) had a CT scan positive for intracranial hemorrhage. Patients with intracranial hemorrhage were more likely to have a positive D-dimer assay (chi-square ? 13.075, p < 0.001). The D-dimer assay had 21 true-positive and four false-negative tests, resulting in a sensitivity of 84.0% (95% CI ? 63.7% to 95.5%) and a specificity of 55.8% (95% CI ? 55.5% to 55.9%). The four false-negative cases included one small intraparenchymal hemorrhage, one small subarachnoid hemorrhage, one moderate-sized intraparenchymal hemorrhage with mid-line shift, and one large subdural hematoma requiring emergent surgery. Conclusions: Due to the catastrophic nature of missing an intracranial hemorrhage in the emergency department, the D-dimer assay is not adequately sensitive or predictive to use as a screening tool to allow routine omission of head CT scanning. [source] Neuropathy-induced apoptosis: Protective effect of physostigmineJOURNAL OF NEUROSCIENCE RESEARCH, Issue 8 2009L. Di Cesare Mannelli Abstract Traumatic, infectious, metabolic, and chemical noxa to the nervous system are the etiology of a crippling disease generally termed neuropathy. Motor disorders, altered sensibility, and pain are the pathognomonic traits. Cellular alterations induced by this chronic pathology include mitochondrial dysfunctions that lead to the activation of the apoptotic cascade. Energy imbalance can compromise the maintenance of mitochondrial membrane potential, furthering the release of cytochrome C and the subsequent cleavage and activation of caspases. Chronic constriction injury (CCI) of the rat sciatic nerve is a neuropathy model able to induce a strong mitochondrial impairment with a consequent apoptotic induction. In this model, the acetylcholinesterase inhibitor physostigmine is administered at 0.125 mg/kg i.p. (twice per day) starting from the operation and for 15 days after. The cholinergic activation reduces cytosolic levels of cytochrome C, suggesting an improved stability of the mitochondrial membrane, and the expression level of the active caspase 3 fragments (19, 16 kDa) is reduced significantly with respect to saline treatment. Accordingly, physostigmine impairs caspase 3 protease activity. In fact, the target of the activated caspase 3, the 89-kDa PARP fragment, is significantly less expressed in the ligated nerve of physostigmine-treated rats, reaching levels that are comparable to those in the contralateral unligated nerve. Finally, this natural acetylcholinesterase inhibitor reduces DNA fragmentation both in the proximal and in the distal parts of the nerve. This protection correlates with the induction of XIAP. Therefore, apoptosis, central to tissue degeneration, is prevented by repeated physostigmine treatment of CCI animals. © 2009 Wiley-Liss, Inc. [source] There Could Never Be a "Peace Traumatic Stress Disorder" The Ground Truth: After the Killing Ends (Documentary)PERSPECTIVES IN PSYCHIATRIC CARE, Issue 3 2008Patricia Foulkrod Director No abstract is available for this article. [source] Reliability of the Color Analog Scale: Repeatability of Scores in Traumatic and Nontraumatic InjuriesACADEMIC EMERGENCY MEDICINE, Issue 5 2009Blake Bulloch MD Abstract Objectives:, The objective was to assess in a pediatric emergency department (ED) the reliability of the color analog scale (CAS) for acute pain assessment, overall and between traumatic and nontraumatic pain etiology. Methods:, This was a prospective study of children aged 5 to 16 years in the ED of a children's hospital who had a complaint of pain. The CAS was administered to the patient at admission and at 30 minutes. To evaluate repeatability, a second measurement was obtained 1 minute following each assessment. This assumed there would be no substantial change in pain intensity within 1 minute. The authors used the intraclass correlation coefficient (ICC) to evaluate the repeatability of 1-minute interval measurements. Results:, A total of 170 patients were enrolled. The origin of pain was traumatic in 81 cases (48%). Regardless of pain etiology, the CAS scores were highly repeatable (r = 0.97, 95% confidence interval [CI] = 0.95 to 0.98). Conclusions:, The color analog scale is both a valid and a reliable self-reporting tool in the assessment of acute pain in children. [source] Previous experience of spontaneous or elective abortion and risk for posttraumatic stress and depression during subsequent pregnancyDEPRESSION AND ANXIETY, Issue 8 2010Lydia Hamama Abstract Background: Few studies have considered whether elective and/or spontaneous abortion (EAB/SAB) may be risk factors for mental health sequelae in subsequent pregnancy. This paper examines the impact of EAB/SAB on mental health during subsequent pregnancy in a sample of women involved in a larger prospective study of posttraumatic stress disorder (PTSD) across the childbearing year (n=1,581). Methods: Women expecting their first baby completed standardized telephone assessments including demographics, trauma history, PTSD, depression, and pregnancy wantedness, and religiosity. Results: Fourteen percent (n=221) experienced a prior elective abortion (EAB), 13.1% (n=206) experienced a prior spontaneous abortion (SAB), and 1.4% (n=22) experienced both. Of those women who experienced either an EAB or SAB, 13.9% (n=220) appraised the EAB or SAB experience as having been "a hard time" (i.e., potentially traumatic) and 32.6% (n=132) rated it as their index trauma (i.e., their worst or second worst lifetime exposure). Among the subset of 405 women with prior EAB or SAB, the rate of PTSD during the subsequent pregnancy was 12.6% (n,51), the rate of depression was 16.8% (n=68), and 5.4% (n,22) met criteria for both disorders. Conclusions: History of sexual trauma predicted appraising the experience of EAB or SAB as "a hard time." Wanting to be pregnant sooner was predictive of appraising the experience of EAB or SAB as the worst or second worst (index) trauma. EAB or SAB was appraised as less traumatic than sexual or medical trauma exposures and conveyed relatively lower risk for PTSD. The patterns of predictors for depression were similar. Depression and Anxiety, 2010.© 2010 Wiley-Liss, Inc. [source] Screening for Adolescent Depression in a Pediatric Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 5 2006Emily Gale Scott MD Abstract Objectives: To describe the prevalence of depressive symptoms in adolescents presenting to the emergency department (ED) and to describe their demographics and outcomes compared with adolescents endorsing low levels of depressive symptoms. Methods: The Beck Depression Inventory,2nd edition (BDI-II) was used to screen all patients 13,19 years of age who presented to the ED during the period of study. The BDI-II is a 21-item self-report instrument used to measure the presence and severity of depressive symptoms in adolescents and adults. Demographics and clinical outcomes of screening-program participants were abstracted by chart review. Patients were categorized into one of four severity categories (minimal, mild, moderate, or severe) and one of three presenting complaint categories (medical, trauma, mental health). Results: Four hundred eighty-seven patients were approached, and 351(72%) completed the screening protocol. Participants endorsed minimal (n= 192, 55%), mild (n= 52, 15%), moderate (n= 41, 11%), or severe depressive symptoms (n= 66, 19%). Those with moderate or severe depressive symptoms were more likely to be hospitalized. Of patients completing the BDI-II, 72% with psychiatric, 12% with traumatic, and 19% with medical chief complaints endorsed either moderate or severe depressive symptoms. Conclusions: Depressive symptoms are prevalent in this screening sample, regardless of presenting complaint. A substantial proportion of patients with nonpsychiatric chief complaints endorsed moderate or severe depressive symptoms. A screening program might allow earlier identification and referral of patients at risk for depression. [source] Incidence and characteristics of lower limb amputations in people with diabetesDIABETIC MEDICINE, Issue 4 2009S. Fosse Abstract Aims To estimate the incidence, characteristics and potential causes of lower limb amputations in France. Methods Admissions with lower limb amputations were extracted from the 2003 French national hospital discharge database, which includes major diagnoses and procedures performed during hospital admissions. For each patient, diabetes was defined by its record in at least one admission with or without lower limb amputation in the 2002,2003 databases. Results In 2003, 17 551 admissions with lower limb amputation were recorded, involving 15 353 persons, which included 7955 people with diabetes. The crude incidence of lower limb amputation in people with diabetes was 378/100 000 (349/100 000 when excluding traumatic lower limb amputation). The sex and age standardized incidence was 12 times higher in people with than without diabetes (158 vs. 13/100 000). Renal complications and peripheral arterial disease and/or neuropathy were reported in, respectively, 30% and 95% of people with diabetes with lower limb amputation. Traumatic causes (excluding foot contusion) and bone diseases (excluding foot osteomyelitis) were reported in, respectively, 3% and 6% of people with diabetes and lower limb amputation, and were 5 and 13 times more frequent than in people without diabetes. Conclusions We provide a first national estimate of lower limb amputation in France. We highlight its major impact on people with diabetes and its close relationship with peripheral arterial disease/neuropathy and renal complications in the national hospital discharge database. We do not suggest the exclusion of traumatic causes when studying the epidemiology of lower limb amputation related to diabetes, as diabetes may contribute to amputation even when the first cause appears to be traumatic. [source] Are CB1 receptor antagonists nootropic or cognitive impairing agents?DRUG DEVELOPMENT RESEARCH, Issue 8 2009Stephen A. Varvel Abstract For more than a decade, a considerable amount of research has examined the effects of rimonabant (SR 141716) and other CB1 receptor antagonists in both in vivo and in vitro models of learning and memory. In addition to its utility in determining whether the effects of drugs are mediated though a CB1 receptor mechanism of action, these antagonists are useful in providing insight into the physiological function of the endogenous cannabinoid system. Several groups have reported that CB1 receptor antagonists enhance memory duration in a variety of spatial and operant paradigms, but not in all paradigms. Conversely, disruption of CB1 receptor signaling also impairs extinction learning in which the animal actively suppresses a learned response when reinforcement has been withheld. These extinction deficits occur in aversively motivated tasks, such as in fear conditioning or escape behavior in the Morris water maze task, but not in appetitively motivated tasks. Similarly, in electrophysiological models, CB1 receptor antagonists elicit a variety of effects, including enhancement of long-term potentiation (LTP), while disrupting long-term depression (LTD) and interfering with transient forms of plasticity, including depolarization-induced suppression of inhibition (DSI) and depolarization-induced suppression of excitation (DSE). The collective results of the in vivo and in vitro studies employing CB1 receptor antagonists, demonstrate that these receptors play integral roles in different components of cognitive processing. Functionally, pharmacological blockade of CB1 receptors may strengthen memory duration, but interferes with extinction of learned behaviors that are associated with traumatic or aversive memories. Drug Dev Res 70:555,565, 2009. © 2009 Wiley-Liss, Inc. [source] Incidence of Traumatic Lumbar PunctureACADEMIC EMERGENCY MEDICINE, Issue 2 2003Kaushal H. Shah MD Abstract Objective: To determine the incidence of traumatic lumbar puncture (LP). Methods: A retrospective study was conducted at an urban, university tertiary care referral center with 50,000 annual emergency department (ED) visits. The study population included all patients who had cerebrospinal fluid (CSF) samples sent to the laboratory between August 15, 2000, and August 14, 2001. The numbers of red blood cells (RBCs) recorded in the first and last CSF tubes, the location where the LP was performed, and the discharge summary and the discharge diagnoses from the particular visit were obtained. All patients with intracranial pathology and CSF obtained via neurosurgical procedure or fluoroscopic guidance were excluded from the study group. Given no clear definition of traumatic LP in the literature, the incidence of traumatic LP was calculated using a cutoff of greater than 400 RBCs (visual threshold for bloody fluid) and 1,000 RBCs (arbitrary threshold selected by other authors) in CSF tube 1. Proportions were compared using chi-square statistics. Results: Seven hundred eighty-six CSF samples were recorded over one year. Twenty-four samples were obtained from patients with intracranial pathology or were obtained via a neurosurgical procedure. Of the remaining 762 CSF samples in the study population, 119 (15.6%) were traumatic using a cutoff of 400 RBCs, and 80 (10.5%) were traumatic, using a cutoff of 1,000 RBCs in tube 1. Five hundred three LPs were done in the ED and 259 were attributed to all other locations in the hospital. Using a cutoff of 400 RBCs, the incidence of traumatic LP in the ED was 13.3%, compared with 20% in the rest of the hospital (p < 0.025). Similarly, using a cutoff of 1,000 RBCs, the incidence of traumatic LP in the ED was 8.9%, compared with 13.5% in the rest of the hospital (p = 0.1). The incidence of "champagne taps" (defined as zero RBCs in the first and last tubes) in the ED was 34.4%, compared with 24.3% in the rest of the hospital (p < 0.01). Conclusions: The incidence of traumatic lumbar puncture is approximately 15% using a cutoff of 400 RBCs and 10% using a cutoff of 1,000 RBCs. In this study, the rate of traumatic lumbar puncture was significantly less (with a cutoff of 400 RBCs) and the rate of champagne tap was significantly greater for LPs done in the ED compared with the rest of the hospital. [source] Life Stories, War, and Veterans: On the Social Distribution of MemoriesETHOS, Issue 1 2004Edna Lomsky-Feder On the basis of examining life stories narrated by 63 Israeli male veterans of the 1973 Yom Kippur War, this article delves into the social construction of personal memory. Focusing on the remembering subject will allow us to study this process by highlighting the agent who creates his or her world, but at the same time it will disclose how society frames and channels the agent's choices. My contention is that personal memory (traumatic or normalizing, conforming or critical) is embedded within, designed by, and derives its meaning from, a memory field that offers different interpretations of war. Yet this memory field is not an open space, and the remembering subject is not free to choose any interpretation he wishes. Cultural criteria "distribute" accessibility to different collective memories according to social entitlement. These "distributive criteria" dictate who is entitled to remember and what is to be remembered, thereby controlling the extent of trauma and criticism of personal memory. [source] Correlation of a high D-dimer level with poor outcome in traumatic intracranial hemorrhageEUROPEAN JOURNAL OF NEUROLOGY, Issue 10 2007J.-R. Kuo The correlations between D-dimer and Glasgow Coma Scale (GCS), pupillary light reflex, distance of midline shift on brain computed tomography (CT), and Glasgow Outcome Score (GOS) in patients with trauma/non-trauma intracranial hemorrhage (ICH) are not consistent in studies. Ninety-eight traumatic and 59 non-traumatic ICH patients were studied. Pre-existing venous thrombosis, recent surgery, drug use (aspirin or coumadin), or malignancy, were excluded. D-dimer level was estimated within hours after acute insult, and statistical analyses were used for comparisons between groups. Traumatic ICH patients had higher D-dimer levels than controls (2984 vs. 256 ,g/l; P = 0.001). The GCS, midline shift on brain CT, pupillary reflex, and GOS at 3 months were significantly correlated with high D-dimer value in traumatic patients (individual P < 0.001), but not in the non-traumatic group. Using receiver-operating characteristic curve (ROC), the cutoff point was 1496 ,g/l, with sensitivity and specificity of 100% and 83%, respectively. D-dimer ,1496 ,g/l predicted a poor outcome [adjusted odds ratio (OR) 14.44, 95% CI 1.16,179.27; P = 0.038]. A high D-dimer level is associated with a poor outcome in patients with traumatic ICH. It can be used in addition to neurological assessment to predict the outcome. [source] Utility of an Initial D-dimer Assay in Screening for Traumatic or Spontaneous Intracranial HemorrhageACADEMIC EMERGENCY MEDICINE, Issue 9 2001Mark E. Hoffmann MD Abstract Objective: To evaluate the sensitivity of a D-dimer assay as a screening tool for possible traumatic or spontaneous intracranial hemorrhage. If adequately sensitive, the D-dimer assay may potentially permit omission of a more expensive computed tomography (CT) scan of the head when such hemorrhage is clinically suspected. Methods: Prospective, consecutive, blinded study of patients (age > 16 years) requiring a CT scan of the head for suspected intracranial hemorrhage over a five-month period at a university, Level I trauma center. All study patients had a serum D-dimer assay obtained prior to their CT scans. Sensitivity and specificity, with 95% confidence intervals (95% CIs), of the enzyme-linked immunosorbent assay (ELISA) D-dimer assay for the detection of intracranial hemorrhage were calculated. Results: Of the 319 patients entered in the study, 25 (7.8%) had a CT scan positive for intracranial hemorrhage. Patients with intracranial hemorrhage were more likely to have a positive D-dimer assay (chi-square ? 13.075, p < 0.001). The D-dimer assay had 21 true-positive and four false-negative tests, resulting in a sensitivity of 84.0% (95% CI ? 63.7% to 95.5%) and a specificity of 55.8% (95% CI ? 55.5% to 55.9%). The four false-negative cases included one small intraparenchymal hemorrhage, one small subarachnoid hemorrhage, one moderate-sized intraparenchymal hemorrhage with mid-line shift, and one large subdural hematoma requiring emergent surgery. Conclusions: Due to the catastrophic nature of missing an intracranial hemorrhage in the emergency department, the D-dimer assay is not adequately sensitive or predictive to use as a screening tool to allow routine omission of head CT scanning. [source] The Origins of Modern DivorceFAMILY PROCESS, Issue 1 2007STEPHANIE COONTZ High rates of marital dissolution and easy access to divorce are not unprecedented, historically or cross-culturally. But contemporary divorce in North America and Western Europe has different origins and features than divorce in previous cultures. The origins of modern divorce patterns date back more than 200 years, to the invention of the historically unprecedented idea that marriage should be based on love and mutual affection. Ironically, then, the fragility of modern marriage stems from the same values that have elevated the marital relationship above all other personal and familial commitments: the concentration of emotion, passion, personal identity, and self-validation in the couple relationship and the attenuation of emotional attachments and obligations beyond the conjugal unit. The immediate causes of divorce may range from factors as diverse as the personal psychological characteristics of one or both spouses to the stresses of economic hardship and community disintegration. But in a larger perspective, the role of divorce in modern societies and its relatively high occurrence both flow from the same complex of factors that have made good marriages so much more central to people's happiness than through most of the past, and deterioration of a marital relationship so much more traumatic. [source] Institutional Mergers in Australian Higher Educaiton since 1960HIGHER EDUCATION QUARTERLY, Issue 4 2000Grant Harman For the past forty years, institutional mergers have been a major and controversial theme in Australian higher education. Three main phases of major mergers are reviewed with particular attention being paid to reasons for merger, success factors, and longer term results. While merger experiences have often been traumatic for participants and participating institutions, on balance the longer term results have been positive, producing a university system today comprising relatively large and comprehensive institutions, well suited to compete in the new internationally competitive environment. [source] Termination as a therapeutic intervention when treating children who have experienced multiple lossesINFANT MENTAL HEALTH JOURNAL, Issue 1 2009Michele M. Many Children who have endured traumatizing events often have a history of prior disruptions and losses which also have been experienced as traumatic. Termination of therapy with these children, therefore, provides a unique opportunity for the clinician to provide the traumatized child and his or her caregiver with a new experience of loss; one that is controlled, predictable, and paced. Through this experience, the child and caregiver can develop a new model for loss, one that permits for losses that are a natural part of healthy growth and change. This article outlines one approach to utilizing termination as an integral component of the therapeutic process with infants, toddlers, and preschoolers and their caregivers. Using a psychodynamic model and working dyadically with the child and the caregiver, termination is approached as a primary intervention, pivotal to the successful treatment of this vulnerable population. [source] Nerve perforation with pencil point or short bevelled needles: histological outcomeACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2010T. STEINFELDT Background: In the case of needle nerve contact during peripheral blocks, pencil point needles are considered less traumatic compared with bevelled needles. However, there are not enough data to prove this notion. Therefore, the aim of this study was to challenge the hypothesis that nerve perforation with short bevelled needles is associated with major nerve damage compared with pencil point needles. Methods: In five anaesthetised pigs, the brachial plexus was exposed bilaterally. Up to eight nerves underwent needle nerve perforation using a pencil point needles cannula or an short bevelled needle. After 48 h, the nerves were resected. The specimens were processed for visual examination and the detection of inflammatory cells (haematoxylin,eosin, i.e. CD68-immunohistochemistry to detect macrophages), myelin damage (Kluver,Barrera staining) and intraneural haematoma. The grade of nerve injury was characterised by an objective score ranging from 0 (no injury) to 4 (severe injury). Results: Fifty nerves were examined. According to the injury score applied, there was no significant difference between the pencil point needles [median (inter-quartile range) 2.0 (2.0,2.0)] and the short bevelled-needle group [median 2.0 (2.0,2.0) P=0.23]. No myelin damage was observed. Signs of post-traumatic inflammation were equally distributed among both groups. Conclusions: In the present study, the magnitude of nerve injury after needle nerve perforation was not related to one of the applied needle types. Post-traumatic inflammation rather than structural damage of nerve tissue is the only notable sign of nerve injury after needle nerve perforation with either needle type. However, neither the pencil point- nor the short bevelled needle can be designated a less traumatic device. [source] Spontaneous rupture of non-parasitic hepatic cystINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 1 2006G. Poggi Summary Intrahepatic cysts are generally classified as congenital, traumatic, infectious or neoplastic. Non-parasitic hepatic cysts (NPHCs) include simple cysts and adult polycystic liver disease in which the liver is diffusely occupied by cysts. NPHCs usually reach a large size before causing symptoms, unless a complication such as rupture, bleeding, infection, obstructive jaundice or neoplastic transformation occurs. We report the case of a 67-year-old man with spontaneous rupture of simple liver cyst. The clinical pictures and the unusual ultrasound features of this rare condition are discussed. [source] Current legal responses to elder abuseINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 4 2006LL.B HONS, Paul Buka MSC Abstract., In this paper, legal provisions for dealing with elder abuse in social or healthcare settings will be considered. The need for such measures for detection and management of elder abuse will be highlighted. Interventions should take into account elderly victims' vulnerability, which may be due to physical and/or psychological dependence. The effectiveness of current interventions is limited due to a lack of cohesion and the absence of a specific legal framework. The term ,vulnerable adults' is broader than ,elder abuse'. It is difficult to estimate the extent of the problem of elder abuse because of the usually intimate settings within which it takes place , this may affect the strength of the evidence. The purpose of this paper is to encourage a debate on the effectiveness of current legal responses to elder abuse. The true figures of the incidence of abuse may never be known. Consequently, in criminal law trials, providing evidence on abuse can be very traumatic and intimidating for a victim because of the circumstances in which it generally takes place. The irony is that the likelihood of a criminal prosecution may be higher in more serious types of abuse where the evidence is overwhelming, on the basis of the res ipsa loquitor (facts speak for themselves) principle. The abuse in question may be domestic or institutional; the effects nevertheless are the same. [source] Bladder wall injury consequent to total hip replacement: Delayed presentationINTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2006ULRICH KALDENBACH Abstract, Bladder injury, although rare, may be traumatic or iatrogenic. We report a patient with greatly delayed presentation of bladder injury after a total hip replacement. [source] Why Bystanders Decline Telephone Cardiac Resuscitation AdviceACADEMIC EMERGENCY MEDICINE, Issue 9 2010Fabrice Dami MD Abstract Objectives:, The aim of this study was to evaluate the rate and reason for refusal of telephone-based cardiopulmonary resuscitation (CPR) instruction by bystanders after the implementation of the dispatch center's systematic telephone CPR protocol. Methods:, Over a 15-month period the authors prospectively collected all case records from the emergency medical services (EMS) dispatch center when CPR had been proposed to the bystander calling in and recorded the reason for declining or not performing that the bystander spontaneously mentioned. All pediatric and adult traumatic and nontraumatic cases were included. Situations when resuscitation had been spontaneously initiated by bystanders were excluded. Results:, During the study period, dispatchers proposed CPR on 264 occasions: 232 adult nontraumatic cases, 17 adult traumatic cases, and 15 pediatric (traumatic and nontraumatic) cases. The proposal was accepted in 163 cases (61.7%, 95% confidence interval [CI] = 54.6% to 66.5%), and CPR was eventually performed in 134 cases (51%, 95% CI = 43.2% to 55.3%). In 35 of the cases where resuscitation was not carried out, the condition of the patient or conditions at the scene made this decision medically appropriate. Of the remaining 95 cases, 55 were due to physical limitations of the caller, and 33 were due to emotional distress. Conclusions:, The telephone CPR acceptance rate of 62% in this study is comparable to those of other similar studies. Because bystanders' physical condition is one of the keys to success, the rate may not improve as the population ages. ACADEMIC EMERGENCY MEDICINE 2010; 17:1012,1015 © 2010 by the Society for Academic Emergency Medicine [source] Making sense of male rape: constructions of gender, sexuality and experience of rape victimsJOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 2 2004Kathy Doherty Abstract This study reports a preliminary investigation into accounting practices for male rape in conversation. Thirty men and women, in dyads, were asked to discuss an incident of male rape presented to them in a vignette. The findings showed that two main issues were discussed: the experience of the rape act and societal responses to male victims. In addition, participants established a ,hierarchy of suffering', where rape was judged to be worse for ,heterosexual' men than it is for ,women' or ,gay' men. Hegemonic, phallocentric representations of heterosexuality were mobilized to argue that acts of rape and consensual intercourse are the same for ,gay' men and ,women' and therefore less traumatic than for ,heterosexual' men. This obscures the violence of rape for gay men and women and exonerates perpetrators by minimizing injury sustained. Participants also argued that heterosexual victims are likely to experience ridicule for having departed from hegemonic masculinity. Arguments were constructed to avoid charges of being dismissive towards women and gay men and of victim blaming in relation to heterosexual men. Copyright © 2004 John Wiley & Sons, Ltd. [source] Sexual assault history, PTSD, and mental health service seeking in a national sample of womenJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 3 2002Sarah E. Ullman This study examined correlates of posttraumatic stress disorder (PTSD) and mental health service seeking for women sexually assaulted in childhood and/or adulthood (N = 619) identified from the National Comorbidity Survey (1990,1992). Factors related to correlates of PTSD and mental health service seeking varied according to sexual assault history. Ethnic minority women with less formal education, more traumatic and stressful life events, and longer duration of sexual abuse had greater odds of PTSD within certain sexual assault history subgroups. Mental health service seeking was predicted by demographics (e.g., more education, Caucasian race), as well as other psychosocial factors (e.g., life events, social support), and medical insurance status, especially for adult sexual assault victims. Implications for mental health treatment and intervention are drawn for women with different sexual assault histories. © 2002 Wiley Periodicals, Inc. [source] Putative heterotopic ossification progenitor cells derived from traumatized muscle,JOURNAL OF ORTHOPAEDIC RESEARCH, Issue 12 2009Wesley M. Jackson Abstract Heterotopic ossification (HO) is a frequent complication following combat-related trauma, but the pathogenesis of traumatic HO is poorly understood. Building on our recent identification of mesenchymal progenitor cells (MPCs) in traumatically injured muscle, the goal of this study was to evaluate the osteogenic potential of the MPCs in order to assess the role of these cells in HO formation. Compared to bone marrow-derived mesenchymal stem cells (MSCs), a well-characterized population of osteoprogenitor cells, the MPCs exhibited several significant differences during osteogenic differentiation and in the expression of genes related to osteogenesis. Upon osteogenic induction, MPCs showed increased alkaline phosphatase activity, production of a mineralized matrix, and up-regulated expression of the osteoblast-associated genes CBFA1 and alkaline phosphatase. However, MPCs did not appear to reach terminal differentiation as the expression of osteocalcin was not substantially up-regulated. With the exception of a few genes, the osteogenic gene expression profile of traumatized muscle-derived MPCs was comparable to that of the MSCs after osteogenic induction. These findings indicate that traumatized muscle-derived MPCs have the potential to function as osteoprogenitor cells when exposed to the appropriate biochemical environment and are the putative osteoprogenitor cells that initiate ectopic bone formation in HO. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:1645,1651, 2009 [source] Apoptosis of human intervertebral discs after trauma compares to degenerated discs involving both receptor-mediated and mitochondrial-dependent pathwaysJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 7 2008Sven K. Tschoeke Abstract Post-traumatic disc degeneration with consecutive loss of reduction and kyphosis remains a debatable issue within both the operative and nonoperative treatment regimen of thoracolumbar spine fractures. Intervertebral disc (IVD) cell apoptosis has been suggested to play a vital role in promoting the degeneration process. To evaluate and compare apoptosis-regulating signaling mechanisms, IVDs were obtained from patients with thoracolumbar spine fractures (n,=,21), patients suffering from symptomatic IVD degeneration (n,=,6), and from patients undergoing surgical resection of a primary vertebral tumor (n,=,3 used as control samples). All tissues were prospectively analyzed in regards to caspase-3/7, -8, and -9 activity, apoptosis-receptor expression levels, and gene expression of the mitochondria-bound apoptosis-regulating proteins Bax and Bcl-2. Morphologic changes characteristic for apoptotic cell death were confirmed by H&E staining. Statistical significance was designated at p,<,0.05 using the Student's t -test. Both traumatic and degenerative IVD demonstrated a significant increase of caspase-3/7 activity with evident apoptosis. Although caspase-3/7 activation was significantly greater in degenerated discs, both showed equally significant activation of the initiator caspases 8 and 9. Traumatic IVD alone demonstrated a significant increase of the Fas receptor (FasR), whereas the TNF receptor I (TNFR I) was equally up-regulated in both morbid IVD groups. Only traumatic IVD showed distinct changes in up-regulated TNF expression, in addition to significantly down-regulated antiapoptotic Bcl-2 protein. Our results suggest that post-traumatic disc changes may be promoted and amplified by both the intrinsic mitochondria-mediated and extrinsic receptor-mediated apoptosis signaling pathways, which could be, in part, one possible explanation for developing subsequent disc degeneration. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:999,1006, 2008 [source] Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomyJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 2 2005Tsung-Jen Huang Abstract The magnitude of the tissue damage from surgery impacts the trauma response. This response is proportional to the severity of surgical stress. Systemic cytokines are recognized as markers of postoperative tissue trauma. Microendoscopic discectomy (MED) recently has become popular for treating lumbar disc herniations, and is associated with favorable clinical outcomes compared with open discectomy (OD). This study postulates that MED is a less traumatic procedure, and therefore has a lower surgical stress response compared to OD. In this study, a quantitative comparison of the overall effects of surgical trauma resulting from MED and OD was performed through analyzing patient systemic cytokines response. From April, 2002 to June, 2003, 22 consecutive patients who had symptomatic lumbar disc herniations were prospectively randomized to undergo either intracanalicular MED (N = 10) or OD (N = 12). In this study, the Vertebroscope System (Zeppelin, Pullach, Germany) was used to perform the endoscopic discectomy procedure in all MED patients. Serum levels of tumor necrosis factor-, (TNF-,), Interleukin-1, (IL-1,), Interleukin-6 (IL-6), and Interleukin-8 (IL-8) were measured before surgery and at 1, 2, 4, 8 and 24h after surgery using an enzyme-linked immunosorbent assay. Serum C-reactive protein (CRP) was measured at the same time interval. The results showed the MED patients had shorter postoperative hospital stay (mean, 3.57 ± 0.98 vs. 5.92 ± 2.39 days, p = 0.025) and less intraoperative blood loss (mean. 87.5 ± 69.4 vs. 190 ± 115 ml, p = 0.042). The operating length, including the set-up time, was longer in the MED group (mean, 109 ± 35.9 vs. 72.1 ± 17.8 min, p = 0.01). The mean size of skin incision made for the MED patients was 1.86 ± 0.13cm (range 1.7,2.0cm); and 6.3 ± 0.98 cm for the OD patients (range 5.5,8cm), p = 0.001. The patients' pain severity of the involved limbs on 10-point Visual Analog Scale before operation in MED group was 7.5 ± 0.3 (range 6,9) and 8 ± 0.2 (range 7,9) in OD group, p = 0.17; and after surgery, 1.5 ± 0.2 (range 1,2) in MED group and 1.4 ± 0.1 (range 1,3) in OD group, p = 0.91. CRP levels peaked at 24h in both groups, and OD patients displayed a significantly greater postoperative rise in serum CRP (mean, 27.78 ± 15.02 vs. 13.84 ± 6.25mg/l, p = 0.026). Concentrations of TNF-,, IL-1,, and IL-8 were detected only sporadically. Serum IL-6 increased less significantly following MED than after OD. In the MED group, IL-6 level peaked 8 h after surgery, with the response statistically less than in the open group (mean, 6.27 ± 5.96 vs. 17.18 ± 11.60pg/ml, p = 0.025). A statistically significant correlation was identified between IL-6 and CRP values (r = 0.79). Using the modified MacNab criteria, the clinical outcomes were 90% satisfactory (9/10) in MED patients and 91.6% satisfactory (11/12) in OD patients at a mean 18.9 months (range 10,25) follow-up. Based on the current data, surgical trauma, as reflected by systemic IL-6 and CRP response, was significantly less following MED than following OD. The difference in the systemic cytokine response may support that the MED procedure is less traumatic. Moreover, our MED patients had achieved satisfactory clinical outcomes as the OD patients at a mean 18.9 months follow-up after surgery. © 2004 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] Diagnosis and Treatment of Heel PainJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 11 2003ANP-C, FAANP, Mary Jo Goolsby EdD The American College of Foot and Ankle Surgeons (ACFAC) clinical practice guideline (CPG) summarizes the literature on the assessment and diagnosis of heel pain. The framework classifies heel pain depending on whether the cause is mechanical, neurological, arthritic, traumatic, or from another origin. Treatment strategies are included for the most common form of heel pain that are caused by mechanical problems. [source] Destructive deformation of the digits with auto-amputation: a review of pseudo-ainhumJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 6 2007RM Rashid Abstract Pseudo-ainhum is an auto-amputation of the digits. Although extremely rare, it is a traumatic and painful experience that can be alleviated with early recognition and intervention. The scientific literature is filled with reports of this interesting but unfortunate phenomenon. To date, a firm causative aetiology has not yet been established. Although reports on this phenomenon have attempted to further our understanding of pseudo-ainhum, a clear understanding has been complicated by the interchangeable use of terms describing this auto-amputation. In this review, we discuss the current understanding, diagnostic criteria, and management of pseudo-ainhum. Furthermore, the nomenclature of pseudo-ainhum is clarified. Ideally, this will allow for more efficient exploration of pseudo-ainhum, its causes, and therapeutic approaches. [source] Cell therapies: realizing the potential of this new dimension to medical therapeuticsJOURNAL OF TISSUE ENGINEERING AND REGENERATIVE MEDICINE, Issue 6 2008Pawanbir Singh Abstract Stem cells promise to treat conditions poorly served by conventional therapeutics. Cells from both embryonic and somatic tissues are being used to create cell therapies for genetic, traumatic and degenerative conditions. The current human, healthcare and fiscal costs of these conditions are significant. This review summarizes the use of stem cells for neurological and cardiac disorders and diabetes to determine the requirements for generic translational research to assist such therapies to be a reality. While there are multiple strategies in each disease area, with no clear favourite, there are clear opportunities in treatments that use a single cell type. A key requirement is to work with pluripotent progenitor cells to cultivate and differentiate a sufficiently large population of functioning cells. Challenges also arise in determining and achieving timely delivery of the correct dose of cells to where they can most effectively treat the disease and best benefit individual patients. Copyright © 2008 John Wiley & Sons, Ltd. [source] Does prior psychological health influence recall of military experiences? a prospective studyJOURNAL OF TRAUMATIC STRESS, Issue 4 2008Jennifer Wilson In a prospective study, we evaluated pre- and postdeployment psychological health on recall of risk factors to assess recall bias. Measures of the General Health Questionnaire (GHQ), PTSD Checklist (PCL), and symptom clusters from the PCL were obtained from 681 UK military personnel along with information on traumatic and protective risk factors. Postdeployment psychological health was more important in explaining recall of traumatic experiences than predeployment psychological health. Predeployment intrusive cluster scores were highly associated with traumatic exposures. Postdeployment, but not predeployment GHQ showed small effects for most risk factors. With the exception of intrusive thoughts, there is insufficient evidence to suggest predeployment psychological status would be useful in correcting for recall bias in subsequent cross-sectional studies. [source] | ||||||||||||||||||||||||||||||||||