Razvan C. Opreanu

Influence of Alcohol on Mortality in Traumatic Brain Injury

Traumatic brain injury (TBI) represents a major public health problem. Each year, 1.4 million people sustain TBI in the United States. 235,000 patients are hospitalized and 50,000 die. The leading cause of TBI in the general population is falls, where rates are highest among children ages 0 to 4 and among adults ages 75 or older. Falls are followed closely by motor vehicle crashes and assaults as overall causes of TBI. However, motor vehicle crashes result in the greatest number of TBI-related deaths and hospitalizations 1. TBI injuries are extremely costly from a public health perspective since they require expenditures for hospital care, extended care, and other medical services, as well as the loss of productivity that may follow the permanent neurological consequences of TBI. For example, the Centers for Disease Control and Prevention estimated that at least 5.3 million patients have a long-term or lifelong need for help with activities of daily living because of TBI 2. As early as 1985, the annual economic burden of TBI in the United States was estimated at

Progesterone Stimulates Proliferation and Promotes Cytoplasmic Localization of the Cell Cycle Inhibitor p27 in Steroid Receptor Positive Breast Cancers

37.8 billion 3, and over the past several years it has increased to almost

Progesterone Decreases Levels of the Adhesion Protein E-Cadherin and Promotes Invasiveness of Steroid Receptor Positive Breast Cancers

60 billion annually 4. One source estimated the cost of acute care and rehabilitation for new cases of TBI at

Appendicitis and Benign Appendiceal Mucocele presenting as Large Bowel Obstruction

9 to

Anatomic Variations of the First Extensor Compartment and Abductor Pollicis Longus Tendon in Trapeziometacarpal Arthritis

10 billion annually in 1999 5. In addition, the psychosocial burden borne by families of individuals with TBI must be taken in account even though it cannot be financially evaluated. Although not all of these figures are from the current decade, it is clear that TBI represents a prevalent and costly public health issue. Alcohol contributes substantially to the morbidity and mortality of trauma patients, regardless of the type of injury suffered 6-9. Serum alcohol levels correlate closely with the extent of injury 10-12. In 2006, alcohol intoxication was involved in 32% of fatal motor-vehicle crashes in the United States 13. Approximately half of the alcohol-related deaths in trauma occur in pre-hospital settings 9, 14. Specifically in TBI, 35-81% of the injured patients are alcohol-intoxicated 15-16 and 42% of the TBI patients were heavy drinkers before injury 16. A study from the National Trauma Databank found similar rates 17. In contrast to the strong correlation between alcohol and pre-hospital mortality in TBI victims, the effects of alcohol on the outcome of injured patients surviving the field and admitted to the hospital is less clear. Indeed, some clinical studies surprisingly seem to suggest a beneficial effect of alcohol in injured patients with TBI. This review will analyze basic research in animal models and available clinical information to provide a realistic perspective regarding the effect of alcohol on the outcome of patients admitted to the hospital with a diagnosis of TBI. The investigational literature can be categorized into studies of the effects of low- moderate doses of alcohol in TBI animal models, investigations into the effects of high doses of alcohol in such models, and experiments directed at elucidating the mechanisms of such effects. We will consider each in turn before moving to the clinical literature.

Whole body imaging in the diagnosis of blunt trauma, ionizing radiation hazards and residual risk.

Progestins are reported to increase the risk of more aggressive estrogen receptor positive, progesterone receptor positive (ER+ PR+) breast cancers in postmenopausal women. Using an in vivo rat model of ER+ PR + mammary cancer, we show that tumors arising in the presence of estrogen and progesterone exhibit increased proliferation and decreased nuclear expression of the cell cycle inhibitor p27 compared with tumors growing in the presence of estrogen alone. In human T47D breast cancer cells, progestin increased proliferation and decreased nuclear p27 expression. The decrease of nuclear p27 protein was dependent on activation of Src and PI3K by progesterone receptor isoforms PRA or PRB. Importantly, increased proliferation and decreased nuclear p27 expression were observed in invasive breast carcinoma compared with carcinoma in situ. These results suggest that progesterone specifically regulates intracellular localization of p27 protein and proliferation. Therefore, progesterone-activated pathways can provide useful therapeutic targets for treatment of more aggressive ER+ PR+ breast cancers.

A new model for health care delivery

Progestins are reported to increase the risk of invasive breast cancers in postmenopausal women receiving hormone therapy with estrogen plus progestin. We report here that estrogen and progesterone receptor positive (ER+PR+) rat mammary tumors arising in the presence of estrogen and progesterone exhibit increased invasiveness and decreased expression of E-cadherin protein compared with tumors growing in the presence of estrogen alone. A similar decrease of E-cadherin expression was observed in human ER+PR+ invasive ductal carcinoma compared with ductal carcinoma in situ. In agreement with findings in the rat, estrogen plus progestin R5020 treatment decreased E-cadherin expression in vitro in T47D human breast cancer cells. Decrease of E-cadherin protein was mediated by progesterone receptor B (PRB) and dependent on the activation of the Wnt pathway. These results suggest that progesterone signaling via PRB contributes to tumor invasiveness and can provide an important therapeutic target for treatment of invasive ER+PR+ breast cancers.

Effective Dose to Dose-Length Product Coefficients for Calculation of CT Effective Dose

IntroductionAppendiceal mucocele is most commonly encountered incidentally during appendectomy.MethodsWe report a case of large bowel obstruction presenting as a closed loop with an appendiceal mucocele as the lead point, superimposed on a chronic ileal stricture that had been misdiagnosed as irritable bowel syndrome.ResultsThe patient underwent ileocecal resection and primary anastomosis. She did well postoperatively, and her irritable bowel syndrome disappeared.ConclusionsAppendiceal mucocele can present in a variety of ways, and surgeons should be alert for atypical presentations. Moreover, some patients with intermittent abdominal pain deserve anatomic investigation before being dismissed as having irritable bowel.

Hematocrit, systolic blood pressure and heart rate are not accurate predictors for surgery to control hemorrhage in injured patients.

Anatomic variation of the trapeziometacarpal joint stabilizing structures is one of the concepts proposed to explain the pathogenesis of trapeziometacarpal arthritis. We undertook this study to test the hypothesis that septation of the first extensor compartment or variation of the abductor pollicis longus (APL) tendon (supernumerary insertions) are more frequently associated with the progression or severity of trapeziometacarpal arthritis. Septation within the first extensor compartment was significantly associated with trapeziometacarpal arthritis (p = 0.013), whereas supernumerary APL insertions (trapezium or thenar) did not reveal a significant association (p = 0.811 and p = 0.937, respectively). The results of this study do not support a role for variations of APL tendon insertions in trapeziometacarpal arthritis. Yet, the presence of septation within the first extensor compartment may play an important role in the pathogenesis of trapeziometacarpal arthritis.

Reduction of Radiation Dose in Pediatric Brain CT Is Not Associated with Missed Injuries or Delayed Diagnosis

Ever since the introduction of radiographic imaging, its utility in identifying injuries has been well documented and was incorporated in the workup of injured patients during advanced trauma life support algorithms [American College of Surgeons, 8th ed. Chicago, 2008]. More recently, computerized tomography (CT) has been shown to be more sensitive than radiography in the diagnosis of injury. Due to the increased use of CT scanning, concerns were raised regarding the associated exposure to ionizing radiation [N Engl J Med 357:2277–2284, 2007]. During the last several years, a significant amount of research has been published on this topic, most of it being incorporated in the BEIR VII Phase 2 report, published by the National Research Council of the National Academies [National Academy of Sciences, Washington DC, 2006]. The current review will analyze the scientific basis for the concerns over the ionizing radiation associated with the use of CT scanning and will examine the accuracy of the typical advanced trauma life support work-up for diagnosis of injuries.