Sicurezza a due ruote

Quella che segue è una raccolta di articoli pubblicati su riviste mediche, specialistiche e non, sulla sicurezza e le moto. Gli articoli, in forma di riassunto ed in inglese, sono stati recuperati tramite il sistema di ricerca bibliografica MedLine© offerto da PubMed del NIH, utilizzando una chiave di ricerca "grezza" e sono aggiornati all'agosto 2001. Non sono ordinati e rappresentano una miscellanea sull'argomento. Sarebbe comunque mia intenzione sistemarli e a rivederli criticamente (se ci riesco) enfatizzando i punti salienti del testo. Per il momento, spulciate....

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Thorac Cardiovasc Surg 2001 Aug;49(4):231-3

Bronchial repair with pulmonary preservation for severe blunt trauma*.

Rocco G, Allen M

Division of General Thoracic Surgery, Mayo Clinic and Mayo Foundation,

Rochester, MN, U.S.A.

[Medline record in process]

After a motorcycle accident, a 22-year-old male was diagnosed with multiple rib

fractures, left-sided tension pneumothorax, hemothorax and left upper lobe

bronchus rupture at its origin. An emergency left thoracotomy revealed an

almost complete avulsion of the upper lobe bronchus from the main stem

bronchus, a severely damaged pulmonary artery, and a concurrent deep

intraparenchymal lower lobe laceration. Since the patient was hemodynamically

stable, a decision was made to preserve as much lung as possible. In the event

of complex pulmonary trauma, pulmonary preservation is desirable since

emergency pneumonectomy is usually associated with high mortality. Early

bronchoscopic assessment, careful anesthetic management, and meticulous

surgical technique with liberal use of fibrin glue were crucial to successful

outcome.

PMID: 11505320, UI: 21396639

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Med J Malaysia 2001 Mar;56(1):77-81

Crash simulation of lower limb with motorcycle basket.

How CK, Megat Ahmad MM, Radin Umar RS, Hamouda AM, Harwant S

Road Safety Research Centre, Universiti Putra Malaysia, 43400 Serdang,

Selangor.

[Medline record in process]

Lower limb injuries are the main cause of temporary and permanent disability

among motorcyclists in Malaysia. They cause non-fatal but serious injuries

requiring hospitalisation. Detailed studies on factors influencing lower limb

injuries are justified in an attempt to reduce the occurrence of these

injuries. This study presents a computer simulation of the crash behaviour of

the basket of a small-engined motorcycle with the lower limb using finite

element (FE) methods. The results suggest that the extensive deformation of the

motorcycle basket may reduce the risk of injury to the lower limb. The

behaviour of the basket during collision is analogous to the crumple zone of

automobiles.

PMID: 11503301, UI: 21395338

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J Endovasc Ther 2001 Jun;8(3):262-7

Endovascular grafting of traumatic aortic aneurysms in contaminated fields.

Kramer S, Pamler R, Seifarth H, Brambs HJ, Sunder-Plassmann L, Gorich J

Department of Radiology, University of Ulm, Germany.

stefan.kraemer@medizin.uni-ulm.de

[Medline record in process]

PURPOSE: To evaluate the potential of endovascular stent-grafts to treat

traumatic aortic lesions in contaminated areas. METHODS: Four patients (3

women; ages 26-78 years) underwent stent-grafting to repair an aortic rupture

sustained in a motorcycle accident, aortic lacerations secondary to surgical

treatment of spondylitis in 2 patients, and an aortobronchial fistula following

surgical thoracic aortic repair 10 years earlier. Stent-grafts (2 Corvita, 1

Talent, and 1 Vanguard) were placed endoluminally into the infected areas via a

transfemoral approach. Follow-up included erythrocyte sedimentation rate, white

blood count, C-reactive protein, blood cultures, and computed tomography (CT).

RESULTS: The stent-grafts were successfully placed in all cases and excluded

the aortic lesion. Under supportive antibiotic therapy, inflammation parameters

returned to normal. CT imaging showed no evidence of paraprosthetic infection,

nor were there any other complications over a follow-up that ranged from 3 to

34 months. CONCLUSIONS: Endovascular therapy may be an alternative in the acute

management of aortic ruptures in the setting of infection. Long-term results

are required for definitive evaluation of the method.

PMID: 11491260, UI: 21383343

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Accid Anal Prev 2001 Sep;33(5):641-8

Helmet laws and motorcycle rider death rates.

Branas CC, Knudson MM

Department of Biostatistics and Epidemiology, University of Pennsylvania School

of Medicine and Philadelphia Veterans Affairs Medical Center, 19104-6021, USA.

cbranas@cceb.med.upenn.edu

[Medline record in process]

We investigated motorcycle rider death rates between states with full

motorcycle helmet laws and those without. This was done using both unadjusted

bivariate analyses and multivariate random-effects generalized least squares

regression models of rider death rates. Multivariate models were adjusted for

the competing influences of several explanatory variables, including the

existence of a motorcycle helmet law. From 1994 to 1996, states with helmet

laws experienced a median death rate of 6.20 riders per 10000 registered

motorcycles and states without helmet laws experienced a median death rate of

5.07 riders per 10000 registered motorcycles (P = 0.008). After controlling for

other factors that affect motorcycle rider fatalities (most notably population

density and temperature), death rates in states with full helmet laws were

shown to be lower on average than deaths rates in states without full helmet

laws (P = 0.740). Our study weakens the claim that rider death rates are

significantly lower in states without full motorcycle helmet laws.

PMID: 11491244, UI: 21383327

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Kaohsiung J Med Sci 2001 Mar;17(3):167-70

Percutaneous transluminal angioplasty as an adjunct to treat the

carotid-cavernous fistula.

Luo CB, Chang FC, Teng MM, Lirrng JF, Chen SS

Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2,

Shih-Pai Road, Taipei, Taiwan. cbluo@vghtpe.gov.tw

[Medline record in process]

We report a case of the direct carotid-cavernous fistula (CCF) with high-grade

stenosis of the internal carotid artery (ICA) and treatment via the

transarterial route after percutaneous transluminal angioplasty (PTA). A

46-year-old man was found to have a CCF after a motorcycle accident.

Transarterial embolization was attempted, but it failed due to stenosis of the

left cervical ICA. After the procedure of PTA for dilatation of the stenotic

ICA, the fistula was successfully obliterated by detachable balloon

subsequently. There were no complications or recurrence of the fistula at the

three-year clinical follow up.

PMID: 11486650, UI: 21379663

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Neurol Neurochir Pol 2000;34(6 Suppl):94-106

Conception of the cervico-brachial protector for motorcycle drivers.

Radek A, Zapalowicz K, Nawrocki A, Demus J, Maklewska E, Matyjewski M

Department of Neurosurgery, Military Medical Academy, Lodz.

The increasing popularity of motorcycles increases the role of motorcycle

accidents as a main cause of brachial plexus injuries. In view of the high

social cost of treatment of the victims it seemed desirable to devise some kind

of protective clothing for motorcyclists. The protective clothing devised by

teams from Department of Neurosurgery, TRICOTEXTIL--and Aeronautics and Applied

Mechanics Institute, consists of the following parts: cervical collar--acting

against force causing lateral bending and extension of cervical spine,

shock-absorptive shoulder pads--acting against the impact energy partially

absorbing it and partially transmitting to the dorsal stiff bar, dorsal stiff

bar and sacroiliac belt--partially immobilizes the thoracic and lumbar spine,

acts against its compression, transmits the impact energy to the iliac crests

and hips. The expected biomechanical effects of the cervico-brachial protector

are as follows: In brachial region it should diminish the impact energy by its

partial absorption and partial transmission along dorsal stiff bar to

sacroiliac belt. It should act against excessive cervical spine motion--mainly

against lateral bending and extension. It should act against excessive

depression of the shoulder. The protective system built in the jacket should

co-operate with the helmet of motorcycle driver. It should be comfortable for

the driver and conform to security standards. Prototype of the protector

underwent kinetic sledge tests in Industrial Motorization Institute (PIMOT),

Warsaw, with the use of Hybrid Dummy II.

PMID: 11452862, UI: 21346676

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Neurol Med Chir (Tokyo) 2001 Mar;41(3):131-4

Proximal M2 false aneurysm after head trauma--Case report.

Ohta M, Matsuno H

Department of Neurosurgery, Kyushu Rosai Hospital, Kitakyushu, Fukuoka.

A 72-year-old male presented with a post-traumatic false aneurysm of the right

proximal M2 artery with massive subarachnoid hemorrhage after closed head

injury. Serial computed tomography (CT) and angiography showed the development

of the aneurysm which was verified at autopsy. He was admitted in a drowsy

state just after a motorcycle accident. Initial brain CT showed subarachnoid

hemorrhage without skull fracture. Follow-up brain CT showed a huge hematoma in

the right temporal lobe. He died 47 hours after the accident. Histological

examination of the aneurysm showed a false aneurysm. Delayed diagnosis of

traumatic aneurysms leads to high mortality, so early surgical treatment is

essential to save such patients.

PMID: 11372556, UI: 21266453

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J Orthop Trauma 2001 May;15(4):299-301

Technique for removing a bent intramedullary femoral nail: a case report.

Ohtsuka H, Yokoyama K, Tonegawa M, Higashi K, Itoman M

Department of Orthopedic Surgery, School of Medicine, Kitasato University,

Sagamihara, Japan.

The authors present a case in which an interlocked intramedullary nail placed

to secure a left femoral shaft fracture was deformed twelve months after

surgery because of secondary trauma. The nail was straightened by sectioning

through half of its diameter with a drill for metal under minimal soft tissue

dissection, then removed and replaced with another nail. The femur subsequently

healed without complications.

PMID: 11371797, UI: 21265157

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Med Sci Law 2001 Apr;41(2):174-7

Incomplete decapitation of a motorcyclist from hyperextension by inertia: a

case report.

Hitosugi M, Fukui K, Takatsu A

Department of Forensic Medicine, Jikei University School of Medicine, Tokyo,

Japan.

This is a rare case involving a motorcyclist. A 57 year old motorcycle rider

wearing a full face type helmet, suffered incomplete decapitation. The autopsy

findings revealed a wide lacerated wound accompanied by extension marks in the

front neck, atlanto-occipital dislocation and complete transection of the

brainstem. According to the police traffic report, the man's head was

stationary at the moment of impact and the remainder of the body continued in a

backward motion. We concluded that the inertia of the torso caused

hyperextension of the neck and subsequent incomplete decapitation.

PMID: 11368401, UI: 21260699

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J Neurosurg 2001 Apr;94(4):621-3

Artificial elevation of brain tissue glycerol by administration of a

glycerol-containing agent. Case report.

Konig K, Rickels E, Heissler HE, Zumkeller M, Samii M

Neurochirurgische Klinik, Medizinische Hochschule Hannover, Germany.

koenig.kathrin@mh-hannover.de

In recent years the development of secondary brain damage and derangement of

neurochemical parameters after severe head injury has been monitored using

microdialysis. Provided the blood-brain barrier is intact, glycerol is regarded

as a potential marker for membrane phospholipid degradation. The authors report

a case in which marked elevation of interstitial glycerol was induced after

exogenous administration of a glycerol-containing agent. A 25-year-old man was

injured in a motorcycle accident and was admitted to the authors' institution

with a unilateral dilated and fixed pupil and a Glasgow Coma Scale score of 3.

Computerized tomography scans revealed a large subdural hematoma on the left

side, subsequent midline shift, and generalized edema. Emergency craniotomy was

performed for evacuation of the hematoma. The patient was prepared for

multisensory monitoring and a microdialysis catheter was inserted into his left

frontal lobe. After a routine enema containing 85% glycerol had been

administered, the authors measured a marked increase in glycerol in the

dialysate. This occurred while the patient was in as stable a condition as

could be expected given the circumstances. The increase in interstitial

glycerol in the injured tissue was most likely due to an impaired blood-brain

barrier. Thus, the interstitial glycerol concentration had been corrupted by

exogenous glycerol, and the marker properties of glycerol in this case became

questionable. Consequently, administration of glycerol, which is frequently

found in various infusions and emulsions, can promote secondary brain damage by

adversely shifting osmotic gradients.

PMID: 11302662, UI: 21197015

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J Air Waste Manag Assoc 2000 Oct;50(10):1734-8

A method for removal of CO from exhaust gas using pulsed corona discharge.

Li X, Yang L, Lei Y, Wang J, Lu Y

College of Mechanical Engineering, Chongqing University, Chongqing City,

People's Republic of China. xhli@cqu.edu.cn

An experimental study of the oxidation of CO in exhaust gas from a motorcycle

has been carried out using plasma chemical reactions in a pulsed corona

discharge. In the process, some main parameters, such as the initial CO

concentration, amplitude and frequency of pulses, residence time, reactor

volume, and relative humidity (RH), as well as their effects on CO removal

characteristics, were investigated. O3, which is beneficial to reducing CO, was

produced during CO removal. When the exhaust gas was at ambient temperature,

more than 80% CO removal efficiency was realized at an initial concentration of

288 ppm in a suitable range of the parameters.

PMID: 11288300, UI: 21183466

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Arthroscopy 2001 Apr;17(4):E16

Tibial plateau fracture after arthroscopic anterior cruciate ligament

reconstruction.

Delcogliano A, Chiossi S, Caporaso A, Franzese S, Menghi A

Department of Orthopaedics, Catholic University, Rome, Italy.

traum.sport@tin.it

Complications have been described with each technique for reconstruction of the

anterior cruciate ligament (ACL) in the knee, both open and arthroscopically

assisted. The authors describe a case of tibial plateau fracture occurring 7

months after an ACL reconstruction using the half tunnel technique. The

fracture occurred at the tibial fixation site and required open reduction with

internal fixation. To our knowledge, only 2 cases of proximal tibial fracture

after patellar tendon autograft ACL reconstruction have been previously

reported. The authors hypothesize that patellar tendon harvesting with bone

blocks and transosseous tibial tunnel can produce a "stress riser" effect and

somehow act synergistically to create decreased strength at the level of

proximal tibial metaphysis.

PMID: 11288026, UI: 21185346

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Am Surg 2000 Oct;66(10):972-4

An unusual case of corneal perforation secondary to Pseudomonas keratitis

complicating a patient's surgical/trauma intensive care unit stay.

Johnson JL, Sagraves SG, Feild CJ, Block EF, Cheatham ML

Department of Surgical Education, Orlando Regional Medical Center, Florida,

USA.

We report a case of corneal perforation secondary to bacterial keratitis caused

by Pseudomonas aeruginosa in a trauma patient in our intensive care unit. A

43-year-old man was involved in a motorcycle crash and suffered multiple

injuries necessitating a prolonged intensive care unit (ICU) stay. Subsequently

P. aeruginosa was cultured from his sputum, blood, and open abdomen. He

developed a bacterial keratitis in his right eye, which also grew P.

aeruginosa. This infection rapidly progressed to corneal perforation requiring

a Gunderson conjunctival flap and lateral tarsorrhaphy in addition to

aggressive antibiotic treatment. At the time of discharge from the hospital the

patient had the return of vision to light only in his right eye. Corneal

perforation is an unusual event in the ICU. Prevention or early detection of

bacterial keratitis with aggressive antibiotic treatment is needed to prevent

such complications. Pseudomonas is one of the more virulent organisms that can

infect the cornea and early identification is paramount for a good outcome.

Management of this complicated case is discussed and the limited amount of

literature on nosocomial bacterial keratitis in the ICU is reviewed.

PMID: 11261627, UI: 21158076

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J Trauma 2001 Feb;50(2):281-8

Female compared with male fatality risk from similar physical impacts.

Evans L

Science Serving Society, Bloomfield Hills, Michigan, USA.

LE@ScienceServingSociety.com

OBJECTIVE: If a female and a male suffer similar potentially lethal physical

impacts, which of them (other factors being equal) is more likely to die? This

question is addressed using 245,836 traffic fatalities. METHODS: Fatality risk

ratios were estimated using crash data for cars, light trucks, and motorcycles

with two occupants, at least one being killed. Combinations of seat belt use,

helmet use, and seating location led to 14 occupant categories. RESULTS:

Relationships between fatality risk and gender are similar for all 14 occupant

categories. Female fatality risk exceeds male risk from preteens to late 50s.

For ages from about 20 to about 35, female risk exceeds male risk by (28 +/-

3)%. CONCLUSION: Whereas specific injury mechanisms differ greatly between the

14 occupant categories, the effect of gender on fatality risk does not, thus

implying that the relationships reflect fundamental gender-dependent

differences.

PMID: 11242293, UI: 21136831

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Accid Anal Prev 2001 May;33(3):353-9

Under-reporting of motor vehicle traffic crash victims in New Zealand.

Alsop J, Langley J

Department of Preventive and Social Medicine, University of Otago Medical

School, Dunedin, New Zealand.

Our aim was to ascertain the extent of under-reporting of seriously injured

motor vehicle traffic crash victims, as recorded by police in New Zealand, and

to what extent this coverage was biased by crash, injury, demographic, and

geographic factors. Hospital data and police records were linked using

probabilistic methods. During 1995, less than two-thirds of all hospitalised

vehicle occupant traffic crash victims were recorded by the police. Reporting

rates varied significantly by age, injury severity, length of stay in hospital,

month of crash, number of vehicles involved, whether or not a collision

occurred, and geographic region, but not by gender, ethnicity or day of the

week of the crash. Those using these police files for prioritization, resource

allocation and evaluation purposes need to be aware of the extent and nature of

these biases contained within these databases.

PMID: 11235797, UI: 21130527

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J Trauma 2001 Jan;50(1):113-5

Fatal blunt aortic injuries: a review of 242 autopsy cases.

Burkhart HM, Gomez GA, Jacobson LE, Pless JE, Broadie TA

IU-Wishard Trauma Center, Indiana University School of Medicine, 1001 West 10th

Street, Indianapolis, Indiana 46202, USA.

OBJECTIVE: To characterize fatal blunt aortic injury (BAI). METHODS: A

retrospective chart review of 242 cases of fatal BAI in patients who underwent

an autopsy at our institution between 1984 and 1997 was performed. Comparisons

were made for statistical differences using the z-test. RESULTS: Two hundred

forty-two cases of fatal BAI were reviewed, making this the largest BAI autopsy

study to date. Mechanisms of BAI included driver/passenger in motor vehicle

crash (MVC) (68%), pedestrian versus MVC (17%), and motorcycle crash (8%). When

comparing the mechanisms in the time period 1984 to 1988 to the time period

1989 to 1997, only the pedestrian versus MVC mechanism was significantly

different (12% vs. 23%, p < 0.05). MVC direction of impact included head-on

(45%), lateral (35%), and complex (20%). Two thirds of the victims sustained

head injuries, rib fractures, and/or hepatic trauma. Only 58% of the victims

had the classic isthmus laceration. There was one preventable death secondary

to delay in diagnosis. CONCLUSION: BAI is not limited to frontal impact

crashes; there should be a high index of suspicion of BAI in lateral impact

crashes as well as pedestrian versus MVC mechanisms. Nonisthmus and complex

aortic lacerations are common in fatal BAI. Finally, BAI is a highly lethal

injury with few preventable deaths in this series.

PMID: 11231680, UI: 21142988

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J Trauma 2001 Jan;50(1):24-30

Crash severity, injury patterns, and helmet use in adolescent motorcycle

riders.

Lin MR, Hwang HF, Kuo NW

Institute of Injury Prevention and Control, Taipei Medical University, 250

Wu-Hsing Street, Taipei, 110, Taiwan.

BACKGROUND: This study examined crash severity and injury patterns between

helmeted and unhelmeted adolescent motorcycle riders. METHODS: Among an initial

population of 4,721 junior college students, 1,284 students were involved in

1,889 motorcycle crashes during a 20-month follow-up period. Crash severity was

measured by both the type of collision object and the repair cost of motorcycle

damage. RESULTS: The incidence rates of crash, injury, hospitalization, and

deaths per 1,000 person-years in the cohort were 358, 104, 14, and 1.3,

respectively. Compared with helmeted riders, unhelmeted riders had more

noncollisions and fewer collisions with a moving car but there was no

significant difference in repair cost of motorcycle damage between these

groups. More injuries to the external skin, face, and head and more severe

injuries occurred in unhelmeted than in helmeted riders. Among crashes

resulting in hospitalization/death, more injuries to the face and head occurred

in unhelmeted riders than in helmeted riders. CONCLUSION: Crashes involving

unhelmeted riders were not more severe but more frequently involved face and

head injuries than crashes involving helmeted riders.

PMID: 11231665, UI: 21142973

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J Adolesc Health 2001 Mar;28(3):228-34

Trends and subgroup differences in transportation-related injury risk and

safety behaviors among high school students, 1991-1997.

Everett SA, Shults RA, Barrios LC, Sacks JJ, Lowry R, Oeltmann J

Division of Adolescent and School Health, National Center for Chronic Disease

Prevention and Health, Centers for Disease Control and Prevention, Atlanta,

Georgia, 30341, USA.

PURPOSE: To examine national trends in transportation-related injury risk and

safety behaviors among U.S. high school students. METHODS: To examine secular

trends in riding with a driver who had been drinking, driving after drinking,

and using seat belts, bicycle helmets, and motorcycle helmets, we used logistic

regression to analyze data from national Youth Risk Behavior Surveys (YRBS)

conducted in 1991, 1993, 1995, and 1997. The YRBS is a self-administered,

anonymous survey that uses a national probability sample of U.S. students in

public and private schools from grades 9-12 (N = 55,734 for all years

combined). RESULTS: The percentages of students who rode with a driver who had

been drinking (36.6% in 1997), drove after drinking alcohol (16.9% in 1997),

always wore seat belts (33.2% in 1997), and always wore a motorcycle helmet

when riding a motorcycle (45.0% in 1997) remained stable between 1991 and 1997.

From 1991 to 1997, the percentage of bicycle riders who always wore a helmet

when bicycling showed a small but statistically significant increase (1.1% in

1991 to 3.8% in 1997), but helmet use remained low. CONCLUSION: Many young

people place themselves at unnecessary risk for motor vehicle- and

bicycle-related crash injuries and fatalities. Improved motor vehicle- and

bicycle-related injury prevention strategies are needed that specifically

target adolescents.

PMID: 11226846, UI: 21124230

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Ann Thorac Surg 2001 Jan;71(1):314-8

Blunt chest trauma with deep pulmonary laceration.

Nishiumi N, Maitani F, Tsurumi T, Kaga K, Iwasaki M, Inoue H

Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa,

Japan. nishiumi@is.icc.u-tokai.ac.jp

BACKGROUND: Deep pulmonary laceration (DPL) is rare and its survival rate is

low. The present study focused on the prognostic factors of DPL. METHODS: The

present study concerned 17 DPL patients treated in Tokai University Hospital

between 1988 and 1998. The prognostic factors of DPL were compared with

systolic blood pressure (SBP), PaO2, and the volume of intrathoracic blood

loss. Characteristic findings of initial chest roentgenograms of DPL were

investigated. RESULTS: Eleven patients were saved and 6 patients died. An SBP

of less than 80 mm Hg on arrival at the hospital and a blood loss of more than

1,000 mL through the chest tube within 2 hours after arrival were poor

prognostic factors. Hypoxemia on arrival was not a poor prognostic factor.

Chest roentgenograms showed macular infiltrative shadow with moderate lung

collapse and deviation of the mediastinal shadow toward the unaffected side.

Selective bronchial occlusion with a Univent prevented suffocation by

intrabronchial blood. CONCLUSIONS: Two poor prognostic factors of DPL are SBP

less than 80 mm Hg on arrival and blood loss of more than 1,000 mL through the

chest tube within 2 hours after arrival.

PMID: 11216768, UI: 21084602

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Ann Plast Surg 2001 Feb;46(2):113-9

One-stage emergency treatment of open grade IIIB tibial shaft fractures with

bone loss.

Tropet Y, Garbuio P, Obert L, Jeunet L, Elias B

Department of Orthopedic, Trauma and Plastic Surgery, Jean Minjoz Hospital,

Besancon, France.

The purpose of this study was to report the authors' experience with emergency

reconstruction of severe tibial shaft fractures. Five male patients were

admitted to the emergency room with a grade IIIB open tibial shaft fracture

with bone loss (average age, 33 years; age range, 18-65 years). Injuries were

the result of motorcycle accidents (N = 2), pedestrian accidents (N = 1),

gunshot wound (N = 1), and paragliding fall (N = 1). Primary emergent one-stage

management for all patients consisted of administration of antibiotics,

debridement, stabilization by locked intramedullary nailing, bone grafting from

the iliac crest, and coverage using free muscle flaps (four latissimus dorsi

and one gracilis). The average follow-up was 21 months (range, 8 months-3.5

years). Partial weight bearing with no immobilization was started at 3 months,

and full weight bearing began 5 months after trauma. No angular complications

and no nonunions were observed. There was one case of superficial infection

without osteitis. All fractures healed within 6 months in 4 patients and within

10 months in 1 patient. At the last follow-up examination, ankle and knee

motion was normal and no pain was noted, except for 1 patient who had

associated lesions (ankle motion reduced by 50%). Aggressive emergency

management of severe open tibial fractures provides good results. It improves

end results markedly, not only by reducing tissue loss from infection, but also

reducing healing and rehabilitation times.

PMID: 11216603, UI: 21084421

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J Med Assoc Thai 2000 Nov;83(11):1296-301

Significance of a widened mediastinum in blunt chest trauma patients.

Sriussadaporn S, Luengtaviboon K, Benjacholamas V, Singhatanadgige S

Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok,

Thailand.

Eighteen blunt chest trauma patients who had mediastinal widening on chest

roengenogram were studied for the correlation with traumatic ruptured of the

aorta or its major branches. Seventeen patients were male and one was female.

The age ranged from 18 to 39 years, mean 26.17+/-6.85SD. The Injury Severity

Score (ISS) ranged from 9 to 34, mean 25.5+/-6.49SD. Fourteen patients (77.8%)

sustained motorcycle accidents, 3 patients (16.7%) sustained car accidents and

1 patient (5.5%) fell from a 4 storey building. All patients underwent

aortography to search for traumatic rupture of the aorta or its major branches.

Six patients had computed tomography of the chest before aortography. Nine

patients (50%) had normal aortography. The remaining 9 patients who had

positive aortography underwent urgent thoracotomies, 8 of them had traumatic

rupture of the aorta or its major branches, the remaining 1 patient had normal

operative finding. Of the 8 patients who had traumatic rupture of the aorta or

its major branches, 1 patient died. The mortality was 12.5 per cent. The rate

of traumatic rupture of the aorta or its major branches in patients who had

blunt chest trauma and widening of the mediastinum on chest roengenogram in our

study was 44.4 per cent. The sensitivity of aortography for diagnosis of

traumatic rupture of the aorta or its major branches was 100 per cent and the

specificity was 90 per cent. On the basis of this study, we conclude that blunt

chest trauma patients with widened mediastinum on chest roengenogram have a

significantly high rate of traumatic rupture of the aorta or its major

branches. All blunt chest trauma patients who have widened mediastinum on chest

reongenogram should undergo further investigations to exclude traumatic rupture

of the aorta or its major branches. We recommend aortography as the

investigation of choice due to its accuracy and usefulness in management plan.

PMID: 11215858, UI: 21083621

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Accid Anal Prev 2001 Mar;33(2):167-72

Age and gender patterns in motor vehicle crash injuries: importance of type of

crash and occupant role.

Tavris DR, Kuhn EM, Layde PM

Department of Preventive Medicine, Medical College of Wisconsin, Milwaukee

53226, USA.

To evaluate the interaction of gender, age, type of crash, and occupant role in

motor vehicle crash injuries leading to hospitalization, we analyzed 1997

Wisconsin hospital discharge data for patients with primary E-code diagnoses of

motor vehicle injuries. The overall ratio of males to females (M/F ratio)

hospitalized for motor vehicle crash injuries was 1.33 (95% confidence interval

(CI): 1.26-1.41). The M/F ratio varied by type of crash and differed for

passengers and drivers. For injuries sustained in collisions between vehicles,

the M/F ratio was 0.96 (95% CI: 0.87-1.05); in loss of control accidents the

M/F ratio was 1.95 (95% CI: 1.76-2.17). Within each type of crash, the M/F

ratio for drivers was similar to that for the entire type; the M/F ratio for

passengers was about half of the type total. Expressed as rates of

hospitalization per 100,000 people in the general population, hospitalizations

of drivers in collisions with another motor vehicle increased steeply in males,

but not in females, beginning at about age 70. For drivers in loss of control

crashes, male rates exceeded female rates in all age groups, with peaks in the

groups 15-24 and 85-89. For passengers, injury rates from collisions with other

motor vehicles were greater for females, especially in the elderly, and injury

rates from loss of control crashes were similar for both genders, with peaks at

15-24 and 85-94. The higher fatality of men in loss of control motor vehicle

crashes, compared to women, suggests an important area for further

investigation.

PMID: 11204886, UI: 21071346

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Accid Anal Prev 2001 Mar;33(2):147-56

Road accidents in Slovenia involving a pedestrian, cyclist or motorcyclist and

a car.

Simoncic M

Institute for Economic Research, Ljubljana, Slovenia. simoncicm@ier.si

We analyse the group of road traffic accidents in Slovenia in which a car

driver and a pedestrian, cyclist or motorcyclist are involved. At the beginning

some basic data are presented from the available database on traffic accidents.

The selected group is then analysed by use of the logistic regression method.

Based on the obtained results, some guidelines for transport policy

action--aimed at decreasing the number of accidents with severe injury or

fatality--are identified.

PMID: 11204884, UI: 21071344

----------

Sex Transm Dis 2001 Jan;28(1):11-3

Motorcycle taxi drivers and sexually transmitted infections in a Peruvian

Amazon City.

Paris M, Gotuzzo E, Goyzueta G, Aramburu J, Caceres CF, Crawford D, Castellano

T, Vermund SH, Hook EW 3rd

University of Alabama at Birmingham, 35294-0007, USA.

BACKGROUND: In Iquitos, Peru, motorcycle taxis are a common form of public

transportation used both by residents and visitors. GOAL: To evaluate the

prevalence of factors associated with sexually transmitted disease risk and of

Neisseria gonorrhoeae and Chlamydia trachomatis infections among motorcycle

taxi drivers working in Iquitos, Peru. STUDY DESIGN: A convenience sample of

motorcycle taxi drivers was recruited through street outreach. Participants

were confidentially interviewed and provided urine specimens for gonococcal and

chlamydial infection testing. RESULTS: A history of sexually transmitted

disease (62%) or symptoms in the past year (35%) and of referral of clients to

commercial sex workers (60%) was common. The prevalence of gonococcal or

chlamydial infection was 3.5%. CONCLUSIONS: Motorcycle taxi drivers are a major

means of public transportation in Iquitos, Peru, have high personal risks for

sexually transmitted disease, and interface often with at-risk persons.

PMID: 11196039, UI: 21037916

----------

J Biomech Eng 2000 Dec;122(6):640-6

Head injury in facial impact--a finite element analysis of helmet chin bar

performance.

Chang CH, Chang LT, Chang GL, Huang SC, Wang CH

Institute of Biomedical Engineering, National Chung Kung University, Tainan,

Taiwan.

The chin bar of a motorcycle helmet protects the rider from facial and head

injuries. To evaluate the protective performance of chin bars against head

injuries from facial impacts, an explicit finite element method was used to

simulate the Snell Memorial Foundation test and a proposed drop test. The

maximum acceleration and Head Injury Criterion (HIC) were employed to assess

the impact-absorbing capability of the chin bar. The results showed that the

proposed approach should be more practical than the Snell test, and provided

more information for improving the chin bar design to protect against head

injuries. The shell stiffness was important in determining the protective

ability of the chin bar, but a chin bar with only an outer shell and comfort

foam offered inadequate protection. An energy-absorbing liner was essential to

increase the protective performance of the chin bar and the liner density

should be denser than that used in the cranial portion of the helmet. For the

chin bar with energy-absorbing liner, a shell design that is less stiff would

provide better protection.

PMID: 11192386, UI: 21032357

----------

Rev Saude Publica 2000 Dec;34(6):636-45

[Health behavior among students of public and private schools in the

metropolitan area of Sao Paulo, Brazil].

[Article in Portugese]

Carlini-Cotrim B, Gazal-Carvalho C, Gouveia N

Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de Sao

Paulo, Sao Paulo, SP, Brasil. bccotrim@usp.br

OBJECTIVE: To investigate the prevalence of several health behaviors among

students of public and private schools in S. Paulo, Brazil. METHODS: An

epidemiological survey about health behaviors among high school students was

carried out in S. Paulo in 1998. Seventh to eleventh graders from ten public

and seven private schools were interviewed. All students were asked to fill out

a Portuguese version of the questionnaire used by the Centers for Disease

Control and Prevention in their annual "Youth Health Risk Behavior Survey".

This questionnaire includes questions on driving-related behavior, violence,

substance abuse, sexual practices, dietary habits and body weight control.

RESULTS: A significant proportion of the students, mainly in the range of

15--18 years old, reported engaging in health-risk behaviors. In public

schools, the most prominent risk behaviors were: riding a motorcycle without

helmets (reported by 70.4% of the students who were either passengers or the

driver); not using condoms in the last sexual intercourse (34% among those

sexually active); carrying guns (4.8% in the last year), and suicide attempts

(8.6% in the last year). In private schools, substance abuse was the most

prominent risk-behavior: 25% reported at least one episode of binge-drinking in

the last 30 days, 20.2% sniffed solvents at least once in the last year and

22.2% smoked marijuana in the same period; 13.8% reported using tobacco on a

regular basis. Not wearing helmets while riding a motorcycle was also very

high, reported by 66.3%. Female students reported less risk-behaviors, except

for suicide attempts and unhealthy weight control methods. CONCLUSIONS: The

information gathered could contribute to the development of preventive programs

at school level, which takes into consideration the students' risk behaviors.

PMID: 11175610, UI: 21108253

----------

Ann Chir Plast Esthet 2000 Dec;45(6):617-21

[Y anastomosis of a free lap on peroneal artery after peroneal osteotomy.

Report of a case].

[Article in French]

Stussi JD, Aboualtout Y, Beau P, Meley M

Service de chirurgie plastique, centre hospitalier regional, hopital Notre-Dame

de Bonsecours, 1, place Philippe de Vigneulles, BP 81065, 57038 Metz cedex 1,

France. jstussi@free.fr

The authors report a case of an Y anastomosis of a free flap on the peroneal

artery. A 30-year-old patient, the victim of a multi-traumatism after a

motorcycle accident, presented open tibia and peroneal fractures and skin

defect at the dorsal aspect of the foot uncovering several fractures and

luxations of the foot. When general state of health allowed the achievement of

a free flap, the authors noted that the two tibial arteries were destroyed with

an extensive thrombosis on each side of the injury which precluded the

reconstruction of a reliable artery axis. The peroneal artery insured alone a

good foot vascularization. A musculocutaneous serratus anterior free flap was

revascularized on the peroneal artery after segmental bone resection on each

side of the peroneal fracture. The necessity to preserve the peroneal artery

for the foot and the diameter of the arteries imposed flowthrough fashion

anastomosis. As a result, the authors believe that anastomosis of a free flap

on peroneal artery is a safe procedure, particularly interesting when a

preoperative peroneal fracture achieved the osteotomy.

PMID: 11147122, UI: 21023853

----------

Plast Reconstr Surg 2000 Dec;106(7):1507-13

Limb salvage of lower-extremity wounds using free gracilis muscle

reconstruction.

Redett RJ, Robertson BC, Chang B, Girotto J, Vaughan T

Department of Surgery, the Johns Hopkins School of Medicine, Baltimore, MD,

USA.

An extensive series reviewing the benefits and drawbacks of use of the gracilis

muscle in lower-extremity trauma has not previously been collected. In this

series of 50 patients, the use of microvascular free transfer of the gracilis

muscle for lower-extremity salvage in acute traumatic wounds and posttraumatic

chronic wounds is reviewed. In addition, the wound size, injury patterns,

problems, and results unique to the use of the gracilis as a donor muscle for

lower-extremity reconstruction are identified. In a 7-year period from 1991 to

1998, 50 patients underwent lower-extremity reconstruction using microvascular

free gracilis transfer at the University of Maryland Shock Trauma Center, Johns

Hopkins Hospital, and Johns Hopkins Bayview Medical Center. There were 22

patients who underwent reconstruction for coverage of acute lower-extremity

traumatic soft-tissue defects associated with open fractures. The majority of

patients were victims of high-energy injuries with 91 percent involving motor

vehicle or motorcycle accidents, gunshot wounds, or pedestrians struck by

vehicles. Ninety-one percent of the injuries were Gustilo type IIIb tibial

fractures and 9 percent were Gustilo type IIIc. The mean soft-tissue defect

size was 92.2 cm2. Successful limb salvage was achieved in 95 percent of

patients. Twenty-eight patients with previous Gustilo type IIIb tibia-fibula

fractures presented with posttraumatic chronic wounds characterized by

osteomyelitis or deep soft-tissue infection. Successful free-tissue transfer

was accomplished in 26 of 28 patients (93 percent). All but one of the patients

in this group who underwent successful limb salvage (26 of 27, or 96 percent)

are now free of infection. Use of the gracilis muscle as a free-tissue transfer

has been shown to be a reliable and predictable tool in lower-extremity

reconstruction, with a flap success and limb salvage rate comparable to those

in other large studies.

PMID: 11129178, UI: 21011592

----------

Br J Dermatol 2000 Dec;143(6):1311-5

Isolation of both Sporothrix schenckii and Nocardia asteroides from a mycetoma

of the forefoot.

Pelzer K, Tietz HJ, Sterry W, Haas N

Department of Dermatology, Medical Faculty (Charite), Humboldt-University

Berlin, Schumannstrasse 20/21, 10117 Berlin, Germany.

Mycetoma is a localized primary subcutaneous infection due to fungi

(eumycetoma) or aerobic actinomycetes (actinomycetoma). We report a patient who

acquired an implantation infection on the forefoot following a motorcycle

accident in Crete. Both Sporothrix schenckii and Nocardia asteroides were

isolated simultaneously from the lesion. Under combined therapy with

itraconazole and trimethoprim-sulphamethoxazole for 7 months the lesion healed

completely. A combination of causative organisms in mycetomas is rare, and the

combination of S. schenckii and N. asteroides together has not been reported

from one lesion.

PMID: 11122041, UI: 20571164

----------

J Hand Surg [Am] 2000 Nov;25(6):1096-9

Scaphocapitate syndrome in an adolescent.

Sawant M, Miller J

Mayday University Hospital, Thornton Heath, Surrey, UK.

Scaphocapitate syndrome is a rare injury and its incidence in immature skeleton

is not well documented. We describe our experience of scaphocapitate syndrome

in a 12-year-old boy and report the results after a 3-year follow-up period.

Treatment involved open reduction internal fixation using K-wires. The 3-year

follow-up evaluation revealed no evidence of avascular necrosis. The wrist was

completely asymptomatic and the patient used it normally. The difficulty in

examining an injured child and the presence of open physes on radiographs can

make diagnosis difficult. Awareness among orthopedic surgeons about this injury

in children is needed to avoid misdiagnosis and to initiate timely treatment.

PMID: 11119668, UI: 20570882

----------

Ital Heart J 2000 Nov;1(11 Suppl):1476-9

[Left atrium rupture after non-penetrating injury to the back].

[Article in Italian]

Malaspina D, Guenzati G, Lemma M, Botta M

Divisione di Cardiologia, Ospedale San Carlo Borromeo, Milano. dan.spin@tin.it

Survival after cardiac rupture associated with blunt thoracic trauma is very

uncommon. In these patients successful management demands a high index of

suspicion of cardiac injury. A case of a 24-year-old woman who presented

unconscious and shocked in the emergency room after motorcycle trauma strictly

limited to her back is reported. Rib and sternal fractures were absent; the

typical signs of cardiac tamponade were not found. Therefore the suspicion of

cardiac chamber rupture was not immediate and the cardiologist was consulted

after several diagnostic exams. Transthoracic echocardiography showed a

pericardial effusion with clots and initial cardiac tamponade. The patient was

transferred to the operating room and a large hemopericardium was disclosed.

Two lacerations were noticed: the first pericardial, near the inferior vena

cava, and the second one in the posterior wall of the left atrium. It is

possible that the associated pericardial tear and pericardial clots could have

contributed to survival. After surgical repair, carried out during

cardiopulmonary bypass, the recovery was quick and complete. This case report

confirms the possibility of heart chamber rupture after blunt chest trauma even

in the absence of obvious thoracic lesion and it shows that the presentation

could be very insidious without a "classic" clinical picture of cardiac

tamponade. In front of an unexplained shock after nonpenetrating thoracic

trauma, a rupture of the heart chambers should be suspected and

echocardiography is mandatory. In the emergency room environment

pericardiocentesis should be performed only with a quickly available cardiac

surgery or in the presence of overwhelming hemodynamic failure.

PMID: 11109199, UI: 20561435

----------

J Pediatr Surg 2000 Nov;35(11):1571-5

Cervical spine trauma in the injured child: a tragic injury with potential for

salvageable functional outcome

Patrick DA, Bensard DD, Moore EE, Calkins CM, Karrer FM

Division of Pediatric Surgery, The Children's Hospital, Denver, CO 80218, USA.

[Record supplied by publisher]

BACKGROUND/PURPOSE: Cervical spine injuries are uncommon in children, and,

therefore, presumptive immobilization and diagnosis remain controversial. The

purpose of this study was to review the author's experience with cervical spine

injuries in children to determine the incidence, injury mechanism, pattern of

injury, and subsequent functional outcome. METHODS: Fifty-two children over a

6-year period (1994 to 1999) with a cervical spine injury secondary to blunt

trauma were identified (1.3% incidence). The functional independent measure

(FIM) was assessed at the time of discharge in each of 3 categories:

communication, feeding, and locomotion. RESULTS: Mean age of the study children

was 10.7 +/- 0.7 years. Eight children (15%) were less than 5 years old, and 4

(8%) were less than 2 years old. The mechanism of injury included motor vehicle

crash (52%), falls (15%), bicycle accidents (11%), sports-related injuries

(10%), pedestrian accidents (8%), and motorcycle crashes (4%). Seven patients

died yielding an overall mortality rate of 13%. Injuries were distributed along

the cervical spinal cord as follows: 5 atlanto-occipital dislocations, 28 C1 to

C3 injuries, 17 C4 to C7 injuries, and 2 ligamentous injuries. FIM scores were

recorded for 18 patients. Seventeen communicated independently, 14 fed

themselves independently, and 12 had independent locomotive function.

CONCLUSIONS: Cervical spine injuries occur in children across a spectrum of

ages. Although atlanto-occipital dislocation is a highly lethal event, children

with C1 to C7 injuries have a high likelihood of reasonable independent

functioning.

PMID: 11083425

----------

Med J Malaysia 2000 Mar;55(1):45-50

Accident characteristics of injured motorcyclists in Malaysia.

Pang TY, Umar RS, Azhar AA, Ahmad MM, Nasir MT, Harwant S

Road Safety Research Centre, Faculty of Engineering, Universiti Putra Malaysia,

Serdang.

This study examines the accident characteristics of injured motorcyclists in

Malaysia. The aim of this study is to identify the characteristics of

motorcyclists who are at higher fatality risk and subsequently be the targeted

group for the fatality-reduction countermeasures. A total of 412 motorcycle

crash victims with serious or fatal injuries were analysed. The results showed

that the injured motorcyclists were predominant young, novice riders of less

than 3 years licensure and male. A fatal outcome was more likely to be

associated with a larger engine capacity motorcycle, collision with a heavy

vehicle, head on collision, and collision at a non-junction road. In contrast,

a non-fatal outcome was more likely to be associated with a small engine

capacity motorcycle, collision with another motorcycle or passenger car,

junction accidents, and side or rear collisions.

PMID: 11072490, UI: 20524561

----------

Med J Malaysia 2000 Mar;55(1):40-4

Compliance of proper safety helmet usage in motorcyclists.

Kulanthayan S, Umar RS, Hariza HA, Nasir MT, Harwant S

Road Safety Research Centre, Faculty of Engineering, Universiti Putra Malaysia.

Motorcyclists make up the largest group of fatalities on Malaysian roads,

majority succumbing to head injuries despite the compulsory safety helmet laws

in the country. One possible reason for this high fatality is improper usage of

safety helmets. This study examines the compliance of proper safety helmet use

in motorcyclists in a typical Malaysian town. Five hundred motorcyclists were

studied. Only 54.4% of motorcyclists used helmets properly, 21.4% used them

improperly; and 24.2% did not wear helmets. Six variables were found to be

significant in improper safety helmet use. They were age, gender, race, formal

education level, prior accident experience and type of license held. Marital

status and riding experience were not significant. Efforts promoting proper use

of safety helmets should focus on the young, male, less formally educated,

unlicensed rider, who has had a prior accident.

PMID: 11072489, UI: 20524560

----------

Med J Malaysia 1999 Dec;54(4):523-5

Traumatic herniation of the heart into the right hemithorax.

Wong PS

Cardiothoracic Surgery Unit, Sultanah Aminah Hospital, Johor Bahru.

Pericardial rupture after blunt chest trauma is described in the literature.

This case report summarises our experience with a 22-year old male patient who

suffered blunt chest trauma during a motor vehicle accident. On admission no

serious injuries could be detected, but 3 hours later, displacement of the

heart to the right hemithorax combined with sudden cardiac failure appeared.

Emergency thoracotomy revealed a right-sided rupture of the pericardium with

complete herniation of the heart into the right pleural cavity and consequent

strangulation by the margins of the pericardial defect.

PMID: 11072475, UI: 20524546

----------

Acad Emerg Med 2000 Sep;7(9):1042-54

Preventive care in the emergency department, Part II: Clinical preventive

services--an emergency medicine evidence-based review. Society for Academic

Emergency Medicine Public Health and Education Task Force Preventive Services

Work Group.

Babcock Irvin C, Wyer PC, Gerson LW

Department of Emergency Medicine, St. John Hospital and Medical Center, and

Department of Emergency Medicine, Wayne State University School of Medicine,

Detroit, MI, USA.

INTRODUCTION: Emergency departments (EDs) provide an opportunity to initiate

preventive services for millions of Americans who have no other source for

these services. OBJECTIVES: To identify primary and secondary preventive

interventions appropriate for inclusion in routine emergency care and,

secondarily, to recommend areas in which research into the efficacy and

cost-effectiveness of interventions is needed. METHODS: Systematic reviews were

performed on 17 candidate preventive interventions with potential applicability

in the ED. All but one was selected from those reviewed by the U.S. Preventive

Services Task Force (USPSTF). Each two-person review team followed a template

that provided a uniform approach to search strategy, selection criteria,

methodology appraisal, and analysis of the results of primary studies bearing

on ED cost-effectiveness. Assigned proctors provided methodological guidance to

the review teams throughout the review process. A grading scheme was developed

that took into account the evidence and recommendations of the USPSTF

supporting primary efficacy of the intervention and the level of evidence

supporting ED application identified by the Society for Academic Emergency

Medicine Public Health and Education Task Force (PHTF) review teams. RESULTS:

Seventeen reviews were completed. The following interventions received an alpha

rating, indicating that evidence is sufficient to support offering these

services in the ED setting, assuming sufficient resources are available:

alcohol screening and intervention, HIV screening and referral (in high-risk,

high-prevalence populations), hypertension screening and referral, adult

pneumococcal immunizations (age >/=65 years), referral of children without

primary care physicians to a continuing source of care, and smoking cessation

counseling. Interventions receiving a beta or gamma rating, indicating that

existing research is not sufficient to recommend for or against instituting

them routinely in the ED, include: identification and counseling of geriatric

patients at risk of falls, Pap tests in women having a pelvic exam in the ED,

counseling for smoke detector use, routine social service screening, depression

screening, domestic violence screening, safe firearm storage counseling,

motorcycle helmet use counseling, and youth violence counseling programs in the

ED. Interventions not recommended for ED implementation (omega rating) include

Pap test screening for women not having a routine pelvic exam, diabetes

screening, and pediatric immunizations. CONCLUSIONS: A set of recommendations

for prevention, screening, and counseling activities in the ED based on

systematic reviews of selected interventions is presented. The applicability of

these primary and secondary preventive services will vary with the different

clinical environments and resources available in EDs. The PHTF recommendations

should not be used as the basis of curtailing currently available services.

This review makes clear the need for further research in this important area.

PMID: 11044002, UI: 20499644

----------

Am J Emerg Med 2000 Oct;18(6):666-70

Gender differences in state-wide EMS transports.

Weiss SJ, Ernst AA, Phillips J, Hill B

University of California Davis Medical Center, Sacramento, USA.

sjweiss@ucdavis.edu

There are gender differences in emergency medical services (EMS) transports and

management based on diagnosis. Data were extracted from the EMS State Ambulance

Transport database. This database exists because of a legal requirement that

all EMS transports generated by 911 calls and all interhospital transports be

reported to the State EMS Bureau. All ambulance transports reported to the

State EMS Division during 1995 were evaluated. Cases were excluded if they were

aborted, admission or discharge transports, outpatient transports, or cases

listed as "other" without a diagnosis. Gender-related treatment differences

were determined for problems for which EMTs have specific treatment options.

These were cardiac arrest, chest pain, allergic reactions, and extremity

fractures. Results were compared using a two-tailed Chi squared or Fischer's

Exact with significance at P < .05. Odds Ratios (OR) and 95% confidence

intervals (CIs) were calculated. There were a total of 164,595 ambulance

transports reported to the State EMS Division. Of these 76,074 (46%) were men

and 88,521 (54%) were women. Of these, 50,211 were excluded. This left 52,607

injury transport and 61,777 illnesses transport. Men were significantly more

likely than women to have injuries related to all-terrain vehicle accidents,

motorcycle accidents, RV accidents, burns, gunshot wounds, and stab wounds. Men

were significantly more likely than women to have illnesses related to cardiac

arrest, dead on arrivals (DOAs), drowning, and smoke inhalation. For cardiac

arrest transports, significantly more male patients presented ventricular

fibrillation, more males received defibrillation, lidocaine, and bicarbonate,

but more women received atropine. Male chest pain patients were more likely to

receive oxygen and morphine and less likely to receive nitroglycerin. Male

allergic reaction patients were more likely to receive an i.v. and subcutaneous

epinephrine. Male extremity fracture patients were more likely to get an i.v.

line, but there was no difference in morphine use or splinting. There are

numerous disease-specific gender differences in the demographics of illness and

injury transported by EMS. The use of various medications and procedures may

also be related to gender. Understanding these differences may help in

preparing EMS professionals for patient management.

PMID: 11043618, UI: 20496334

----------

Jpn J Thorac Cardiovasc Surg 2000 Sep;48(9):579-82

Traumatic cardiac rupture with acute ascites.

Koyama T, Miyamoto S, Murakami H, Kitanaka Y, Ikeshita M, Yamate N

Department of Surgery, St. Marianna University School of Medicine, Kawasaki,

Japan.

A rare accumulation of serous ascites following traumatic cardiac rupture is

reported for a 21-year-old man transferred to the emergency center of our

hospital from a community hospital suffering from severe shock due to a

motorcycle accident. Computed tomography scan showed moderate pericardial and

intrapelvic fluid accumulation strongly suggesting cardiac and visceral

injuries. An emergency sternotomy disclosed a rupture of the right atrial

appendage, successfully closed with primary sutures. A laparotomy was done to

aspirate moderate serous fluid, which was clear and not bloody. Edema of the

retroperitoneal space and hepatic congestion were noted with no accompanying

organ injury. Ascites pathogenesis is unknown but appeared to be related to

portal venous congestion induced by cardiac tamponade combined with massive

intravenous fluid infusion done to correct the patient's deteriorating

hemodynamics.

PMID: 11030130, UI: 20484636

----------

Am J Orthop 2000 Sep;29(9 Suppl):22-6

Free-flap reconstruction of traumatic lower extremity wounds.

Hammert WC, Minarchek J, Trzeciak MA

Department of Plastic Surgery, The Cleveland Clinic Foundation, Ohio, USA.

A retrospective review of 20 free-tissue transfers for reconstruction of

traumatic lower extremity wounds was undertaken. The wounds consisted of

Gustilo type IIIb injuries resulting from motor vehicle accidents, falls,

motorcycle and four-wheel, all-terrain vehicle accidents, and a laceration from

a lawnmower blade. Fifty percent of the procedures were for open tibia

fractures. The most common flap used was the rectus abdominis, followed by the

latissimus dorsi, serratus anterior, and radial forearm. There were two major

complications resulting in flap loss. Adequate and multiple debridements,

selection of the appropriate flap, meticulous surgical technique, and

postoperative care continue to be the essentials of free-flap coverage. With a

motivated patient, limb salvage and return to function can be achieved after

most high-energy injuries.

PMID: 11011776, UI: 20464371

----------

Rev Med Chil 2000 May;128(5):529-32

[Traumatic rupture of thoracic aorta and non operative treatment of concomitant

splenic lesion. Case report].

[Article in Spanish]

Espinoza R, Aguilera H, Irarrazaval MJ, Bosch E

Servicio de Urgencia, Hospital del Trabajador de Santiago.

We report a 26 years old male that suffered a motorcycle accident resulting in

a traumatic aortic rupture and splenic laceration. He was subjected to a

surgical repair of the aortic lesion under complete heparinization. The splenic

rupture was non operatively managed successfully.

PMID: 11008358, UI: 20463638

----------

An Esp Pediatr 2000 Mar;52(3):271-4

[Traumatic pulmonary pseudocyst].

[Article in Spanish]

Diaz Conradi A, Carreras Lavila M, Garcia-Henares A, Garcia-Pagan R, Moral

Garcia A, Mateu Navarro M, Tobena Boada L

Servicio de Pediatria, Hospital Mutua de Terrassa.

Traumatic pulmonary pseudocyst is an unusual complication that appears after a

closed thoracic trauma. It is produced as a consequence of outburst and shear

forces released by the impact on the elastic thoracic wall. We present a

14-year-old boy who, after a motorcycle crash, presented a traumatic pulmonary

pseudocyst, isolated on the right hemithorax. The patient's evolution was good.

The antecedent of trauma, together with radiological examination and the

tendency toward spontaneous resolution, suggested the diagnosis as well as the

advisability of a conservative approach in most pediatric cases. Recognition of

this unusual disorder would help to avoid unnecessary diagnostic and

therapeutic procedures.

PMID: 11003907, UI: 20460780

----------

Inj Prev 2000 Sep;6(3):184-8

Impact of a helmet law on two wheel motor vehicle crash mortality in a southern

European urban area.

Ferrando J, Plasencia A, Oros M, Borrell C, Kraus JF

Institut Municipal de Salut Publica, Ajuntament de Barcelona, Spain.

jferrand@imsb.bcn.es

BACKGROUND: In Spain, a federal road safety law went into effect in the fall of

1992 extending to urban areas the unrestricted use of safety helmets by all two

wheel motor vehicle occupants. OBJECTIVES: To assess the effect of the law in

reducing fatal motorcycle crash injuries; to estimate the number of lives

saved; and to determine changes in the distribution of severity and anatomical

location of injuries. METHODS: Pre-test/post-test design of all deaths of two

wheel motor vehicle occupants from 1990-92 (pre-law period) and from 1993-95

(post-law period) detected by the Barcelona Forensic Institute and the city

police department. Injuries were coded using the 1990 version of the

abbreviated injury scale. Poisson regression methods were used to model trends

in mortality ratios and to provide estimates of the number of lives saved.

RESULTS: Between 1993 and 1995, 35 lives of two wheel motor vehicle occupants

were spared, representing a decrease of 25% in the observed motorcycle crash

mortality in the post-law period when compared with what would be expected if

no such law had gone into effect. The proportion of deaths with severe head

injuries was also reduced from 76% to 67% in the post-law period. CONCLUSIONS:

This study offers the first evaluation of a helmet law using combined forensic

and police data in a large south European urban area where there is widespread

use of motorcycles. Our results confirm the effectiveness of the helmet law, as

measured by the reduction in the number of deaths and mortality ratios after

the law implementation. The findings reinforce the public health benefits of

mandatory non-restricted motorcycle and moped helmet use, even in urban areas

with lower traffic speeds.

Publication Types:

Evaluation studies

PMID: 11003182, UI: 20456515

----------

J Air Waste Manag Assoc 1999 Sep;49(9 Spec No):100-7

The impact of particulate matter on daily mortality in Bangkok, Thailand.

Ostro B, Chestnut L, Vichit-Vadakan N, Laixuthai A

Office of Environmental Health Hazard Assessment, California Environmental

Protection Agency, Oakland, USA.

Several studies conducted in U.S. cities report an association between acute

exposures to particulate matter (PM), usually measured as PM10, and mortality.

Evidence of high concentrations of PM10 in Eastern Europe and in large

metropolitan areas outside of the United States, such as Mexico City and

Bangkok, underscores the need to determine whether these same associations

occur outside of the United States. In addition, conducting studies of

mortality and air pollution in regions that have distinctly different seasonal

patterns than those of the United States provides an effective opportunity to

assess the potentially confounding aspects of seasonality. Over the last few

years, daily measures of ambient PM10 have been collected in Bangkok, a

tropical city of over 6 million people. In this metropolitan area, PM10

consists largely of fine particles generated from diesel- and gasoline-powered

automobiles, and from two-stroke motorcycle engines. Our analysis involved the

examination of the relationship between PM10 and daily mortality for 1992

through 1995. In addition to counts of daily natural mortality (total mortality

net of accidents, homicides, and suicides), the data were compiled to assess

both cardiovascular and respiratory mortality, and natural mortality by age

group. A multivariate Poisson regression model was used to explain daily

mortality while controlling for several covariates including temperature,

humidity, day of the week, season, and time. The analysis indicated a

statistically significant association between PM10 and all of the alternative

measures of mortality. The results suggest a 10-microgram/m3 change in daily

PM10 is associated with a 1-2% increase in natural mortality, a 1-2% increase

in cardiovascular mortality, and a 3-6% increase in respiratory mortality.

These relative risks are generally consistent with or greater than those

reported in most studies undertaken in the United States.

PMID: 11002832, UI: 20457933

----------

Med J Malaysia 1996 Mar;51(1):143-5

Road traffic accidents in patients with obstructive sleep apnoea.

Liam CK, How LG, Tan CT

Department of Medicine, Faculty of Medicine, University of Malaya, Kuala

Lumpur.

Three patients involved in road traffic accidents were suspected to have

obstructive sleep apnoea (OSA). Two of them fell asleep while riding

motorcycles and one patient fell asleep behind the wheel of a truck causing it

to overturn. The diagnosis of OSA in each case was suspected based on a history

of loud snoring, restless sleep, and excessive daytime somnolence and was

confirmed by sleep studies.

PMID: 10967996, UI: 20423705

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Br J Sports Med 2000 Aug;34(4):308-9

Anabolic steroid accelerated multicompartment syndrome following trauma.

Bahia H, Platt A, Hart NB, Baguley P

Department of Plastic Surgery, Kingston General Hospital, Hull, United Kindgom.

The case is reported of a 23 year old male body builder who was involved in a

road traffic accident after taking anabolic steroids. The resulting trauma

caused a severe life threatening acute multicompartment syndrome resulting in

the need for urgent multiple fasciotomies.

PMID: 10953907, UI: 20407995

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J Am Acad Orthop Surg 2000 Jul-Aug;8(4):266-75

Olecranon fractures: treatment options.

Hak DJ, Golladay GJ

University of California - Davis School of Medicine, Sacramento, CA 95817, USA.

Fractures of the olecranon process of the ulna typically occur as a result of a

motor-vehicle or motorcycle accident, a fall, or assault. Nondisplaced

fractures can be treated with a short period of immobilization followed by

gradually increasing range of motion. Open reduction and internal fixation is

the standard treatment for displaced intra-articular fractures. Stable internal

fixation with figure-of-eight tension-band wire fixation for simple transverse

fractures allows early motion to minimize stiffness. Use of two knots produces

symmetric tension at the fracture site and provides more rigid fixation than a

single knot. Care should be taken to ensure that the tension-band wire and the

proximal ends of the Kirschner wires are positioned deep to the triceps fibers

to prevent wire migration. If the anterior cortex is engaged, overpenetration

of the wires into the soft tissues should be avoided. Plate fixation is

appropriate for severely comminuted fractures, distal fractures involving the

coronoid process, oblique fractures distal to the midpoint of the trochlear

notch, Monteggia fracture-dislocations of the elbow, and nonunions. For

comminuted fractures and nonunions, a dorsally applied limited-contact

dynamic-compression plate with supplemental bone graft should be utilized to

support comminuted depressed articular fragments. A one-third tubular

hook-plate can be used for fractures with a small proximal fragment for which

additional fixation of the olecranon tip is desired. Fragment excision and

triceps advancement is appropriate in selected cases in which open reduction

seems unlikely to be successful, such as in osteoporotic elderly patients with

severely comminuted fractures.

Publication Types:

Review

Review, tutorial

PMID: 10951115, UI: 20409270

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Med J Malaysia 2000 Jun;55(2):45-50

Accident characteristics of injured motorcyclists in Malaysia.

Pang TY, Radin Umar RS, Azhar AA, Megat Ahmad M, Mohad Nasir MT, Harwant S