T. Belzunegui

Chronic alcoholism decreases neuronal nuclear size in the human entorhinal cortex

The effect of chronic alcoholism in the neuronal nuclear area (karyometry) of the lateral entorhinal cortex at three rostro-caudal levels (rostral, intermediate and caudal) has been studied in 19 alcoholic subjects and in 15 aged-matched controls. Cases were distributed into three groups according to their age (29-44, 45-60 and 61-70 years of age). In the second group (45-60 years), the nuclear size in layers II and III of the caudal entorhinal cortex showed a very significant decrease compared to controls. The first group (29-44 years) also showed a significant reduction in size, while the third group presented the smallest differences. The presence of cirrhosis in the alcoholic group did not vary the observed results. Thus, chronic alcoholism significantly decreases the nuclear size in layers II and III of the lateral entorhinal cortex, and thus the entorhinal output to the hippocampus may be altered in alcoholism.

Major trauma registry of Navarre (Spain): the accuracy of different survival prediction models☆

OBJECTIVE To determine which factors predict death among trauma patients who are alive on arrival at hospital. METHODS Design prospective cohort study method. Data were collected on 378 trauma patients who were initially delivered by the emergency medical services of Navarre (Spain) with multiple injuries with a new injury severity score of 15 or more in 2011-2012. These data related to age, gender, presence of premorbid conditions, abbreviated injury score, injury severity score, new injury severity score (NISS), revised trauma score (RTS), and prehospital and hospital response times. Bivariate analysis was used to show the association between each variable and time until death. Mortality prediction was modeled using logistic regression analysis. RESULTS The variables related to the end result were the age of the patient, associated comorbidity, NISS, and hospital RTS. Two models were formulated: in one, the variables used were quantitative, while in the other model these variables were converted into dichotomous qualitative variables. The predictive capability of the two models was compared with the trauma and injury severity score using the area under the curve. The predictive capacities of the three models had areas under the curve of 0.93, 0.88, and 0.87. The response times of the Navarre emergency services system, measured as the sum of the time taken to reach the hospital (median time of 65 min), formulate computed tomography (46 min), and perform crucial surgery (115 min), when required, were not taken into account. CONCLUSION Age, premorbid conditions, hospital RTS, and NISS are significant predictors of death after trauma. The time intervals between the accident and arrival at the hospital, arrival at the hospital and the first computed tomography scan or the first crucial emergency intervention, do not appear to affect the risk of death.

Extravasation of radiographic contrast material and compartment syndrome in the hand: a case report

Radiocontrast agents are a type of medical contrast material used to improve the visibility of internal bodily structures in X-ray based imaging techniques such as computed tomography (CT) or radiography. Radiocontrast agents are typically iodine or barium compounds.Extravasation of contrast is a possible complication of imaging studies performed with contrasts. Most extravasations cause minimal swelling or erythema, however, skin necrosis, ulceration and compartment syndrome may occur with extravasation of large volumes of contrast.A case report is presented in which significant extravasation of contrast was caused while injecting the contrast intravenously into the back of the hand of a 50 year old patient during computed tomography. The patient was undergoing chemotherapy. The patient developed a compartment syndrome and a fasciotomy was required. Treatment options are outlined and emphasis is made on prevention of this iatrogenic complication.Some of the preventive measures to avoid these complications include use of non-ionic contrast (low osmolarity), careful choice of the site of intravenous administration, and close monitoring of the patient during injection of contrast to minimize or prevent extravasation injuries. Clear information to patients and prompt recognition of the complication can allow for other non-surgical treatment options than the one required in this case.

A new survival status prediction system for severe trauma patients based on a multiple classifier system

BACKGROUND AND OBJECTIVE Severe trauma patients are those who have several injuries implying a death risk. Prediction systems consider the severity of these injuries to predict whether the patients are likely to survive or not. These systems allow one to objectively compare the quality of the emergency services of trauma centres across different hospitals. However, even the most accurate existing prediction systems are based on the usage of a single model. The aim of this paper is to combine several models to make the prediction, since this methodology usually improves the performance of single models. MATERIALS AND METHODS The two currently used prediction systems by the Hospital of Navarre, which are based on logistic regression models, besides the C4.5 decision tree are combined to conform our proposed multiple classifier system. The quality of the method is tested using the major trauma registry of Navarre, which stores information of 462 trauma patients. A 10x10-fold cross-validation model is applied using as performance measures the specificity, sensitivity and the geometric mean between the two former ones. The results are supported by the usage of the Mann-Whitneys U statistical test. RESULTS The proposed method provides 0.8908, 0.6703 and 0.7661 for sensitivity, specificity and geometric mean, respectively. It slightly decreases the sensitivity of the currently used systems but it notably increases the specificity, which implies a large enhancement on the geometric mean. The same behaviour is found when it is compared versus four classical ensemble approaches and the random forest. The statistical analysis supports the quality of our proposal, since the obtained p-values are less than 0.01 in all the cases. CONCLUSIONS The obtained results show that the multiple classifier systems is the best choice among the considered methods to obtain a trade-off between sensitivity and specificity.

Short-term ethanol intoxication in rat. Effect on the entorhinal cortex.

The effect of short-term ethanol intoxication in systems implicated in memory and other cognitive functions in rats has been assessed by studying the variation in the karyometry of the neurons in the different layers of the lateral entorhinal cortex. The analysis showed that short-term ethanol consumption produced a reduction in the nuclear area of neurons in layers V and VI, and to a lesser extent, in layers II and III. These results suggest that the deep layers of the entorhinal cortex are more sensitive to ethanol intoxication, thus more likely affecting cortical and subcortical projections than the hippocampal output.

Hemoneumotórax espontáneo masivo idiopático en una mujer joven

The massive acute hemopneumothorax is a clinical entity often make grants in the context of major trauma. The spontaneous hemopneumothorax is much more uncommon and usually is the result of a pneumothorax complicated by bleeding due to rupture of blebs or adhesions. Rarer still is that this is massive. Different strategies have been recommended in the treatment of such patients among which is the thoracoscopy as a way to solve the possible bleeding. We report the case of a woman of 18 who presented a spontaneous and massive hemopneumothorax being treated in a center that did not have thoracic surgery was moved to a higher level hospital where a chest tube was placed solve the problem without sequelae. We consider it important not to attempt a chest drain in a hospital that does not have the ability to perform thoracoscopy because of an inability to stop the bleeding if necessary