Prediction of rib fracture injury outcome by an artificial neural network

Outcome-based therapy is becoming the standard for assessing patient care efficacy. This study examines the ability of an artificial neural network to predict rib fracture injury outcome based on 20 intake variables determined within 1 hour of admission. The data base contained 580 patient records with four outcome variables: Length of hospital stay (LOS), ICU days, Lived, and Died. A 522-patient training set and a 58-patient test set were randomly selected. Nine networks were set up in a feed-forward, back-propagating design with each trained under different initial conditions. These networks predicted the test set outcome variables with an accuracy as high as 98% at the 80% testing level. Internal weight matrix examination indicated that age, ventilatory support, and high trauma scores were strongly associated with both ICU days and mortality. Being female, injury severity, and injury type were associated with increased LOS. Smoking and rib fracture number were low-level predictors of the four outcome variables.

The Sparklet carbon dioxide resuscitator

The use of carbon dioxide in resuscitation was advocated in the 1920s and 1930s. A device, the Sparklet Resuscitator, was marketed to allow the administration of carbon dioxide gas. This piece of equipment is described and the indications for its use in resuscitation reviewed. The use of carbon dioxide appeared to have a degree of support and success as a 'universal' aid to resuscitation.

Thermogenesis after surgery: effect of perioperative heat conservation and epidural anesthesia

Body temperature, respiratory gas exchange, and plasma catecholamines were determined before and after surgery in three groups [control (C), warmed (W), and epidural (E) who received local anesthetic at T4-S5 dermatomes during and for 24 h after surgery] of patients undergoing colonic surgery under general anesthesia. At the end of surgery, group W were nursed in an ambient temperature of 28-30 degrees C, whereas the others were at 20-23 degrees C for a period of 24 h. Core (Tc) and dorsal hand temperature decreased during surgery in both C and E (P less than 0.05) but not in W. After surgery, Tc increased similarly in C and E and by a smaller amount in W. Plasma catecholamine concentrations increased significantly in C and W but not in E (P less than 0.001), with the greatest response occurring in C. Postoperative oxygen consumption and carbon dioxide production exceeded preoperative values (P less than 0.01) in C but not in W or E. After surgery, plasma albumin fell and C-reactive protein increased similarly in all three groups. Thus body heat conservation or epidural blockade attenuates or abolishes the rise in plasma catecholamines and oxygen consumption postoperatively but does not prevent the increase in Tc or the acute phase protein response.

Bovine rotavirus segment 5 protein expressed in the baculovirus system interacts with zinc and RNA

The cDNA sequence of genomic segment 5 of bovine rotavirus (RF strain) has been inserted into baculovirus transfer vectors, downstream of the polyhedrin promotor. Recombinant baculoviruses containing gene 5 were selected and the protein was expressed to high yields in Spodoptera frugiperda cells. The recombinant protein was inoculated into rabbits and mice to produce specific hyperimmune antisera. The polyclonal antiserum reacted with a protein in rotavirus-infected MA104 cells and with a protein translated in vitro. This serum was also used to confirm that the gene 5 protein is not a structural protein. Recently, the gene 5 product has been predicted to be a zinc finger protein and reported to contain a highly conserved arrangement of cysteine residues; here, we demonstrate that the recombinant gene 5 protein binds zinc and is an RNA-binding protein as are several other zinc finger proteins.

Interaction of rotavirus particles with liposomes

We have studied the interactions of purified viral particles with liposomes as a model to understand the mechanism of entry of rotavirus into the cell. Liposomes, made from pure as well as mixed lipids, that contained encapsulated self-quenching concentrations of the fluorophore carboxyfluorescein (CF) were used. Rotavirus-liposome interactions were studied from the fluorescence dequenching of CF resulting from its release to the bulk solution. Purified infectious double-shelled virus particles induced a concentration- and temperature-dependent release of CF. The rate and extent of CF release was maximum between pH 7.3 and 7.6. The removal of outer structural proteins VP4 and VP7 from virus, which results in the formation of single-shelled particles, prevented virus interaction with liposomes. Rotavirus particles with uncleaved VP4 did not interact with liposomes, but treatment in situ of these particles with trypsin restored the interaction with the liposomes and resulted in CF dequenching. Our data support the view that rotavirus enters the cell through direct penetration of the plasma membrane. In contrast, adenovirus, the only other nonenveloped virus studied by this method, shows the optimum rate of marker release from liposomes at around pH 6 (R. Blumenthal, P. S. Seth, M. C. Willingham, and I. Pastan, Biochemistry 25:2231-2237, 1986). The interaction between rotavirus and liposomes is sensitive to specific divalent metal ions, unlike the adenovirus-liposome interaction, which is independent of them.

Is hysteria on the wane? A community survey in West Bengal, India

A field survey was conducted in two villages--Gambhirgachi and Paharpur--in 1972. The survey was repeated after 10 years in the former village and after 15 years in the latter one. The second survey showed very little change in the rate of total mental morbidity. The rate of prevalence of hysteria declined significantly in both villages. In Gambhirgachi the rate of hysteria dropped from 16.9 to 4.6 per 1000 in 10 years, and in Paharpur it dropped from 32.3 to 2.05 per 1000 in 15 years.

Diffusion properties of clathrin on the surface of isolated mouse liver nuclei by the fluorescence recovery after photobleaching technique

Clathrin labeled with eosin maleimide showed physicochemical properties similar to the native clathrin. The diffusion coefficients of clathrin protomers and cages measured at 20 degrees C by the fluorescence recovery after photobleaching technique (FRAP) were found equal to (9 +/- 1).10(-8) cm2.s-1 and (3 +/- 0.4.10(-8) cm2.s-1, respectively. After incubation with isolated mouse liver nuclei suspended in an aqueous buffer, FRAP measurements showed that 78% of clathrin was immobilized on the nuclear surface. This immobile fraction might correspond to aggregates of molecules resembling coated pits. The mobile fraction had a diffusion coefficient of 2.5.10(-9) cm2.s-1 which was reduced seven times when the suspension medium of the nuclei contained 50% sucrose, showing that the aqueous phase exerted an important drag on the clathrin molecules motion diffusing on the nuclear surface.

Contagious hysteria in a West Bengal village

This article reports on the phenomenon of contagious hysteria in a village in West Bengal. The psychosocial and psychodynamic aspects are discussed.

Early intracardiac repair of large ventricular septal defects with conventional cardiopulmonary bypass and moderate hypothermia

With the use of conventional cardiopulmonary bypass and moderate hypothermia, primary intracardiac repair of large ventricular septal defects was performed in 30 children below the age of two years. All babies were falling to thrive and suffered from cardiac failure resistant to medical therapy, or had evidence of early pulmonary vascular disease. Two patients died after the operation, giving an operative mortality of 6.7%. Twenty-eight survivors have been followed for periods of one month to two and a half years. All are thriving and have normal or mildly enlarged hearts on their chest skiagrams. Primary intracardiac repair of large ventricular septal defects can be performed in infants and small children with a low operative risk when the standard cardiopulmonary bypass technique is being used.

Recurrent spontaneous pneumothorax; an effective method of talc poudrage

Between January 1977 and December 1978, 24 patients with recurrent or chronic spontaneous pneumothorax were treated in the Hong Kong University Cardiothoracic Centre at Grantham Hospital by talc pleurodesis. Talc poudrage had been carried out under local infiltration anesthesia by a technique that utilizes the Venturi principle and the help of an oxygen injector, used normally for ventilating a patient during bronchoscopy with a rigid bronchoscope. By using this method of poudrage, a uniform application of the powder over the whole pleural surface can be achieved and successful pleurodesis can be obtained in all patients under local anesthesia.

Incidence of postoperative deep vein thrombosis in Hong Kong Chinese

Postoperative deep vein thrombosis is considered to be rare in Chinese. The 125I-labelled fibrinogen test was used to determine the true incidence of postoperative deep vein thrombosis in Chinese. Deep vein thrombosis was found in 2.6 per cent, a very low incidence compared with Caucasian series.

Lipothymoma

Two cases of asymptomatic lipothymoma, discovered on "routine" roentgenograms of the chest, are presented. Thirty well-documented reports of this tumor in the English literature are reviewed. The pertinent points concerning this rare clinicopathological entity are summarized and discussed.

Y incision for median sternotomy

Between July 1968 and June 1977, in the University of Hong Kong Department of Surgery, 1,083 patients underwent operations via a median sternotomy using a Y incision. Of these patients, 1,070 had open heart surgery, eight had total thymectomy and in five patients pericardectomy was carried out. The overall wound complication rate was 2.31%, with a wound infection rate of 1.24%. The main advantage of a Y incision is that it leaves a better cosmetic appearance than the usual vertical incision because the upper end of the scar is at a much lower level. The incidence of subcutaneous haematoma and subsequent wound infection is much lower with the Y incision, whereas the T incision is associated with a high rate of both these complications due to the large upper flap that one has to create and mobilize to expose the suprasternal area. While using the Y incision, one only requires a small V-shaped upper flap to obtain access to the suprasternal space.

Coexistent bronchogenic carcinoma and active pulmonary tuberculosis

Sixty-four cases of coexistent bronchogenic carcinoma and active pulmonary tuberculosis were diagnosed between 1969 and 1976. The majority were male chronic cigarette smokers in their fifth and sixth decades. Human bacilli were isolated in 48 patients (88.9 percent) and atypical bacilli in six patients (11.1 percent). All of the atypical bacilli and 8.3 percent of the human bacilli were found to be resistant to the first line antituberculous drugs. All patients, except two who died following resection, were given a course of antituberculous drugs with 93.8 percent successful sputum conversion. Uncontrolled or disseminated tuberculous infection was not observed. Forty-five patients (70.3 percent) underwent pulmonary resection. Median survival time of those who had curative resection was 14.3 months with a 5 year survival rate of 13.2 percent. Median survival times of those treated by palliative resection plus anticancer chemotherapy and by anticancer chemotherapy alone were 8.3 months and 11.1 months, respectively. None of these patients survived more than 30 months. It appears that, clinically, each disease runs its own course with little effect on the other.

Foreign body in the oesophagus: review of 2394 cases

A total of 2394 patients with a foreign body in the oesophagus was treated in our unit between 1965 and 1976, including 343 children in whom fish bones (146) and coins (134) were most commonly responsible; in adults, bones (fish and chicken) were commonest. Most of the foreign bodies were impacted in the cervical oesophagus. Pharyngoscopy and oesophagoscopy were carried out under general anaesthesia in all cases except those in which the foreign body was ejected spontaneously or when the patient refused the examination. Oesophageal perforation due to a foreign body was encountered in only one child. Two patients in the series developed the fearsome complication of oesophagoaortic fistula.

An unusual lethal complication associated with Starr-Edwards prosthetic aortic valve holder

This is the first report of an unusual fatal complication associated with the Starr-Edwards prosthetic aortic valve holder. The patient died 51 days after replacement of his aortic valve with a Starr-Edwards prosthetic aortic valve. The cause of death was coronary arterial embolus caused by a fragment broken off of the prosthetic aortic valve holder.

Surgery of isolated patent ductus arteriosus: a new technique of suture and division

Since mid-1973 29 cases of isolated patent ductus arteriosus were treated in the Hong Kong University surgical unit with a new technique of suture and division. This technique has almost eliminated the problem of intraoperative haemorrhage and its consequences.

Mediastinoscopy in the diagnosis of thoracic disease

One hundred and forty-one patients have undergone mediastinoscopy in the Hong Kong University Surgical Unit since March 1974. Among these there were 109 cases of bronchogenic carcinoma. In approximately 50% of these patients the carcinoma had already spreed to involve the mediastinal lymph nodes at the time of examination. Mediastinoscopy may be the only source of positive histological proof of the diagnosis in bronchogenic carcinoma as well as in other types of intrathoracic disease such as tuberculosis. We believe that mediastinoscopy reduces the number of unnecessary exploratory thoracotomies.

Closure of pericardium after open heart surgery. A way to prevent postoperative cardiac tamponade

Between July 1968 and December 1975, 821 patients underwent open heart operations. In 596 cases the pericardium was left open and in 225 the pericardium was closed. Forty-one patients in the open pericardium group required reoperation and 23 of these had tamponade. Four patients in the closed pericardium group had reoperation but there was not a single case of tamponade. In most cases that required reoperation the bleeding was from extrapericardial sources. Absence of tamponade in the closed pericardium group can be explained by the fact that blood from extrapericardial sources of bleeding cannot collect round the heart because the pericardium is closed. Thus closure of pericardium helps to prevent tamponade. Reoperations some months or years after the original operation are technically easier and less hazardous if the pericardium has been closed because the closed pericardium prevents the heart from becoming adherent to the back of sternum and also because there are fewer adhesions in the pericardial cavity.