bluuebunny/crossref_metadata_2025 huggingface dataset:
ACE inhibition and fibroblast growth factor in cultured human vascular smooth muscle
Authors: Tang Lilong , Both Katrin , Taylor Roger
Published: January 2007

The effects of the angiotensin converting enzyme (ACE) inhibitor, enalaprilat, and basic fibroblast growth factor (bFGF) on DNA synthesis and expression of ACE mRNA were examined in human vascular smooth muscle cells cultured from saphenous vein and internal mammary artery.

DNA synthesis was estimated using 3H-thymidine uptake, and ACE mRNA was estimated by rt-PCR. Enalaprilat (0.125 mg/ml, 48 h) decreased 3H-thymidine uptake to 66 - 12% (SE) of the control without enalaprilat (p, 0.05). Basic FGF (10 ng/ml, 24 h) increased uptake by 41 - 12% (p, 0.05) while enalaprilat pretreatment (24 h) decreased uptake to 56 - 12% of this augmented value (p, 0.025). Basic FGF increased ACE mRNA, a process that was time dependent with an approximately 50% increase after 24 h exposure. Pre-exposure to enalaprilat (24 h) before bFGF reduced ACE mRNA to approximately 50% of that found in the presence of bFGF alone.

The results indicate that ACE mRNA is present in human vascular smooth muscle cells and that exposure to an ACE inhibitor reduces DNA synthesis. Basic FGF stimulates DNA synthesis and ACE mRNA expression, and both of these effects are reduced by an ACE inhibitor. The results are consistent with the effects of bFGF being exerted through, or alternatively in concert with, angiotensin II. Further, they suggest that ACE inhibition can reduce the activity of the renin-angiotensin system by inhibiting the production of ACE, or at least the expression of ACE mRNA, in addition to producing enzyme inhibition at the ACE level.
The correlation between the severity of peripheral arterial disease and carotid occlusive disease
Authors: Long Tayler H , Criqui Michael H , Vasilevskis Eduard E , Denenberg Julie O , Klauber Melville R , Fronek Arnost
Published: January 2007

Peripheral arterial disease (PAD) and carotid occlusive disease (COD) are both known to be specific manifestations of atherosclerosis. Because they both have a common cause, it is reasonable to hypothesize that they should correlate with each other to a certain extent, and previous studies have shown that there is a correlation between the prevalence of PAD and COD. The purpose of this study was to determine whether a correlation exists between the severity of PAD and the severity of COD by retrospectively looking at a group of 203 patients who underwent non-invasive testing for suspicion of PAD at the San Diego VA Hospital or UCSD Medical Center, and who also had a non-invasive duplex carotid scan. The severity of PAD was assessed by segmental blood pressure ratios (leg segment/arm ratio) in each leg taken at the toe, ankle, and below the knee, as well as the peak flow velocity of the posterior tibial artery. The severity of COD was assessed by duplex ultrasound scans of six distinct segments of the carotid artery system: the right and left common, internal, and external carotid arteries. Correlation analysis showed r = 0.23 (p = 0.001) when comparing a PAD aggregate standard score with the number of diseased carotid arteries (.50% stenosis), and r = 0.23 (p = 0.001) when comparing a PAD aggregate standard score with an average COD score. Because about 50% of the patients had undergone surgical intervention on their leg or carotid arteries, another correlation analysis restricted to patients with no surgical interventions (n = 97) was performed. The above correlations were slightly attenuated in this analysis, r = 0.21 (p = 0.043) and r = 0.17 (p = 0.092), respectively. The results indicate that there is a modest but significant correlation between the severity of PAD and the severity of COD in a population with a high prevalence of both.
Hemochromatosis associated with endothelial dysfunction: evidence for the role of iron stores in early atherogenesis
Authors: Lekakis John , Papamichael Christos , Stamatelopoulos Kimon , Cimponeriu Adriana , Voutsas Anastasios , Vemmos Konstantinos , Mavrikakis Myron , Stamatelopoulos Stamatios
Published: January 2007

Impaired endothelium-dependent, flow-mediated dilatation of the brachial artery was observed in a 50-year-old premenopausal female non-smoker with idiopathic hemochromatosis. Endothelial dysfunction observed in this patient supports a relationship between body iron stores and early atherosclerotic process.
Neuroprotection in acute ischaemic stroke. II: Clinical potential
Authors: Davis Michelle , Barer David
Published: January 2007

In the 4 years since our first article, there has been considerable progress in our understanding of the pathophysiology of acute ischaemic stroke, and the results of well-conducted trials have at last begun to change everyday clinical practice. The timing of the various processes of the ischaemic cascade and the potential time windows for different interventions are better understood. Furthermore, the importance of maintaining cerebral perfusion and optimizing systemic physiological and biochemical factors in order to prevent neurological deterioration (`progressing stroke') is increasingly being realized.

Numerous antithrombotic and neuroprotective drugs have been evaluated in clinical trials, and while none has shown unequivocal benefits on its own, prospects for successful intervention are still good. This will probably involve different combinations of treatments targeted on different pathophysiological stroke types, so that the management of acute stroke will offer a considerable challenge to the stroke physicians of the future.
Platelets and stroke
Authors: Smith Nicholas M , Pathansali Rohan , Bath Philip MW
Published: January 2007

Platelets are anucleate cells with little or no capacity for de novo protein synthesis. Their potential haemostatic reactivity is established at or before thrombopoiesis by their precursor cell, the bone marrow megakaryocyte. In some pathologic conditions, the megakaryocyte-platelet-haemostatic axis (MPHA) becomes perturbed, resulting in the formation of hyperfunctional platelets which may contribute to the development of vascular disease or an acute thrombotic event such as ischaemic stroke or myocardial infarction. Laboratory measurements of platelet function have established that platelet reactivity is accentuated in acute ischaemic stroke, particularly following cortical rather than lacunar infarction. Whether accentuated platelet function is a cause or a consequence of stroke is not yet clear, but it is likely that patients with certain risk factor profiles have some degree of platelet activation preceding the stroke. Further work into the MPHA is required to establish whether enhanced post-stroke platelet reactivity can be referred to the megakaryocyte. The antiplatelet agents tested to date are effective in secondary but not primary prevention of stroke. This probably reflects the diverse patho-physiology of stroke: accentuated platelet function is only likely to be a significant factor in cortical stroke.
Subfascial endoscopic perforator vein surgery: indications and results
Authors: Gloviczki Peter
Published: January 2007

Subfascial endoscopic perforator surgery (SEPS) is a new, minimally invasive technique performed in patients with advanced chronic venous insufficiency. The objective of the operation is to interrupt incompetent medial calf perforating veins to decrease venous reflux and reduce ambulatory venous hypertension in critical areas above the ankle where venous ulcers most frequently develop. Patients with stasis skin changes and healed or active venous ulcerations are potential candidates for the operation. Preoperative evaluation is performed with duplex scanning of the superficial, deep and perforator system, to diagnose both obstruction and valvular incompetence. Results of the North American SEPS Registry (NASEPS) as well as experience in several individual centers confirmed that the operation has significantly fewer wound complications than the classic open surgical techniques, and that rapid ulcer healing can be achieved. At the Mayo Clinic an ulcer recurrence rate of 12% was observed, with recurrence significantly more frequent in post-thrombotic limbs than in patients with primary venous valvular incompetence. The NASEPS Registry report confirmed a 2-year cumulative ulcer recurrence rate of 28%; ulcer recurrence was significantly more frequent in post-thrombotic limbs, especially in those with deep venous obstruction.

SEPS is a new, low-risk, outpatient procedure that effectively decreases perforator reflux in patients with venous ulcerations, and should be added to our armamentarium to treat patients with advanced chronic venous disease. Long-term prospective and randomized studies are, however, still required to provide level I evidence of late efficacy.
Kawasaki disease
Authors: Newburger Jane W , Burns Jane C
Published: January 2007

Kawasaki disease is a leading cause of acquired heart disease in children in the USA. An acute vasculitis of unknown etiology, it occurs predominantly in infancy and early childhood, and more rarely in teenagers. Coronary artery aneurysms or ectasia develop in approximately 15-25% of children with the disease. Treatment with intravenous gamma globulin, 2 g per kg, in the acute phase reduces this risk three-to fivefold. Angiographic resolution occurs in approximately one-half of aneurysmal arterial segments, but these show persistent histologic and functional abnormalities. The remainder continue to be aneurysmal, often with development of progressive stenosis or occlusion. The worst prognosis occurs in children with so-called `giant aneurysms', i.e. those with a maximum diameter greater than 8 mm, because thrombosis is promoted both by sluggish blood flow within the massively dilated vascular space and by the frequent development of stenotic lesions. Serial stress tests with myocardial imaging are mandatory in the management of patients with Kawasaki disease and significant coronary artery disease to determine the need for coronary angiography and transcatheter interventions or coronary bypass surgery. Continued long-term surveillance in patients with and without detected coronary abnormalities is necessary to determine the natural history of Kawasaki disease.
Essential fatty acids and cardiovascular disease: the Edinburgh Artery Study
Authors: Leng Gillian C , Taylor Gillian S , Lee Amanda J , Fowkes F Gerry R , Horrobin David
Published: January 2007

The aim of this study was to determine whether plasma and red cell fatty acid levels were associated with cardiovascular disease, and whether any association was independent of other major risk factors. Over 1100 subjects were examined in a random sample survey of the general population (the Edinburgh Artery Study). Fatty acids were measured in three plasma fractions (triglyceride, cholesteryl ester and phospholipid) and in red cell phospholipids. Fatty acid levels in groups with cardiovascular disease (myocardial infarction (MI), angina and lower limb disease) were compared with a no disease group. In the cholesteryl ester and phospholipid fractions there were significantly lower levels of eicosapentaenoic acid in the MI group on univariate analysis (p,0.05), but not when adjusted for age, sex, smoking and systolic blood pressure using logistic regression. In the red cell fraction, alpha-linolenic acid was significantly lower in those with stroke (p,0.01) and lower limb disease (p,0.05). Linoleic acid was significantly raised in the triglyceride fraction in those with MI, probably reflecting recent dietary changes. There were significant increases in dihomo-gamma-linolenic acid in the phospholipid and red cell fractions in those with MI, and in the phospholipid fraction in the stroke group. These results do not support the hypothesis that n-6 fatty acids are protective against cardiovascular disease, although there may be some beneficial effects of the n-3 fatty acid, alpha-linolenic acid. Results from cross-sectional surveys must, however, be interpreted with caution because the presence of disease may affect dietary intake.
Lipid-lowering and skin vascular responses in patients with hypercholesterolaemia and peripheral arterial obstructive disease
Authors: Khan Faisel , Litchfield Stuart J , Stonebridge Peter A , Belch Jill JF
Published: January 2007

Elevated blood cholesterol is a major risk factor for atherosclerosis. Recent studies show that lowering cholesterol reduces the risk of vascular disease, but the precise mechanisms for vascular improvement are not fully understood. Furthermore, it is not known whether the beneficial effects of cholesterol lowering extend to the skin microvasculature. In this unrandomized, open design study, we used iontophoresis and laser Doppler flowmetry to examine forearm skin perfusion in hypercholesterolaemic patients with PAOD before and after cholesterol-lowering therapy with fluvastatin.

Endothelium-dependent and -independent vasodilatation were measured following skin iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP), respectively.

Before cholesterol-lowering, vascular responses to ACh and SNP were reduced significantly in patients compared with responses in control subjects (p, 0.001 and p, 0.05, ANOVA, respectively). Fluvastatin therapy (40 mg/day) for 24 weeks significantly reduced total cholesterol (7.3 6 0.3 to 6.0 6 0.2 mmol/l, p, 0.001) and LDL cholesterol (5.4 6 0.5 to 4.2 6 0.4 mmol/l, p, 0.01). Vasodilatation to SNP was significantly improved at week 24 (p, 0.05).

In patients with hypercholesterolaemia and PAOD, cholesterol-lowering with statin therapy significantly improved endothelium-independent vascular responses to SNP in skin microvessels. The application of the non-invasive techniques of iontophoresis and laser Doppler flowmetry may provide useful markers for the assessment of microvascular function in this group of patients.
Pathological fractures of the extremities
Authors: Cool Paul , Grimer Rob
Published: January 2007

Pathological fractures of the appendicular skeleton due to tumours are relatively uncommon. Patients who are older than 50 years are most likely to have a metastasis, while patients who are younger than 20 are more likely to have a primary bone neoplasm.

In all fractures, but especially those that present after minimal trauma, one should have a high index of suspicion that the fracture might be pathological. Correct diagnosis prior to treatment is essential and we have constructed a protocol for this. In the assessment of these tumours a multidisciplinary assessment with radiologist, pathologist, oncologist and orthopaedic surgeon, is essential. The patient will require both oncological and surgical treatment. The aims of surgical treatment are firstly to stabilize the fracture with a construct that will outlive the patient and second to improve the patient’s mobility and to relieve pain.

Advances in oncological treatment have prolonged the survival of patients with primary and metastatic bone disease. This puts increasing strains on the surgical construct, therefore the choice of surgical reconstruction needs to be carefully considered. We outline the assessment of a patient who presents with a pathological fracture in three phases and describe a treatment protocol.
Albumin: friend or foe?
Authors: Gosling Peter
Published: January 2007

In the absence of red blood cells or any other colloid, human albumin has saved thousands of lives since its first use in 1941. However, for general volume expansion purposes including trauma resuscitation, published evidence suggests that albumin has now been superseded by synthetic colloids, which are more effective volume expanders, have vascular protective effects and are cheaper.
Mass gathering medicine
Authors: Hines Ken
Published: January 2007

The historical perspective of mass gatherings is reviewed and similarities between modern and historic disasters are identified. Previous legislative changes have tended to be reactive to a mass gathering disaster. Current legislation and good practice guidance concentrates on prevention and high standards of safety. Detailed careful multi-agency planning is required for all significant mass gatherings in an attempt to minimize risks and maximize safety. Integrated emergency planning is essential in dealing with the evermore complex and challenging mass gatherings.
Assessment and management of limb injuries in the pre-hospital environment
Authors: Green M , Greaves I , Porter K
Published: January 2007

Limb trauma is probably the commonest injury that a pre-hospital carer will encounter. In isolation it is rarely life threatening and it should be remembered that the care of the airway, breathing and circulation must taken precedence. Exceptionally a limb injury influences the care of the above, for example external blood loss from a injury that requires immediate haemorrhage control. Limb injuries may pose multiple problems to pre-hospital care personnel particularly with regard to immobilization, appropriate pain relief and subsequent safe painless extrication.
Conservative management of penetrating torso trauma
Authors: Hyde Jonathan AJ , Walsh Michael S , Graham Timothy
Published: January 2007

Trauma has evolved as a specialty of its own over the past two decades, and has been the subject of much research and a huge number of trials, many of which are ongoing. As a result, it is now possible to apply an evidence-based practice to many trauma scenarios. The management of penetrating injuries to the chest or abdomen has traditionally followed a policy of emergency surgery as the first course of action. This has now shown to be unnecessary in many cases, particularly with the advances in diagnostic tests and imaging modalities. A large number of cases of penetrating torso trauma may require an operation at some stage, but obtaining the clearest diagnostic picture and optimizing the clinical condition of the patient before this undertaking will result in improved outcome. A selective approach to emergency surgery, with its attendant difficulties, is now recommended
Management of simple and complex ankle fractures
Authors: Cooper Julian
Published: January 2007

Ankle fractures constitute a considerable part of the trauma surgeon's workload. Although many injuries are straightforward, a high proportion merit surgical intervention. Decision-making depends on recognition of the fracture pattern and its associated ligament injuries. An understanding of the mechanism of injury helps fracture diagnosis as this enables prediction of damaged structures. Fractures in the elderly present difficulties in dealing with poor bone quality, but by modification of technique satisfactory results may be obtained. The mechanism and management of ankle fractures is discussed including current controversies, open fractures and post-traumatic osteoarthritis.
Current consensus and controversies in major burns management
Authors: Judkins Keith
Published: January 2007

Most doctors in Britain receive some training in the care of the burned patient, if not as an undergraduate then as part of training in accident and emergency medicine or in the Advanced Trauma Life Support (ATLS®) course. Because major burn injury presents infrequently to the average district hospital, most of this training is rusty by the time it is needed. Further, most have little opportunity to catch up with developments in this very specialized area of trauma medicine.

This paper aims to address some of these shortcomings by describing recent advances in burn care and highlighting areas of current debate. The fluids used for resuscitation, improved options for treatment, the status of ongoing discussions about treatment facilities and the state of the art in managing smoke inhalation are reviewed. Some pointers to the future and to avenues for research are suggested.
Adult prehospital scoring systems: a critical review
Authors: Batchelor JS
Published: January 2007

The goal of trauma triage is to get the right patient to the right place at the right time. In an attempt to achieve this objective numerous authors have developed a variety of prehospital triage tools. Comparative evaluation to determine which of the currently developed triage tools has the greatest predictive power has been prevented mainly because of the varying definitions of major trauma. The use of small data sets and the absence of model validation techniques have also prevented the true worth of these triage tools from being accurately determined. The aim of this article is to critically appraise the major prehospital triage tools.
Autologous blood transfusion in trauma
Authors: Bulger Eileen M , Maier Ronald V
Published: January 2007

Transfusion of autologous blood, recovered from the surgical field, has been widely accepted for use in elective cases with significant blood loss. The use of these techniques in the setting of exsanguinating traumatic haemorrhage has been limited, however, by a number of confounding issues. These include: (a) the potential for increased infectious complications resulting from the reinfusion of blood from a contaminated field; (b) the risk of exacerbating a consumptive coagulopathy; (c) a potential increased risk of multiple organ failure syndrome due to the infusion of cytokines and activated inflammatory mediators; (d) the practicality and logistics of this approach in the moribund patient; and (e) the cost-effectiveness of this technology. The purpose of this review is to evaluate the current literature addressing these issues and better define the role for autologous transfusion in the trauma population.
Arthroscopy of the wrist for trauma
Authors: Herron ML , Craigen MAC
Published: January 2007

Over the last decade wrist arthroscopy has proven itself to be a very useful procedure in the management of both bony and soft tissue injuries of the region. Access is achieved through the potential spaces between the dorsal extensor tendons, overlying the joint. Distraction of the wrist joint and instillation of fluid distends the cavity to allow inspection and therapeutic procedures. The radio-carpal and mid-carpal, as well as distal radio-ulna articular surfaces and associated intrinsic and possibly some extrinsic carpal ligaments, are well visualized and dynamic testing of structures is possible. In terms of diagnosis of carpal ligament and triangular fibrocartilage complex (TFCC) injuries it consistently outperforms imaging modalities available. It has also lead to a greater appreciation of the high incidence of occult chondral and ligamentous injury that may co-exist with intraarticular fractures, although the significance of these injuries is debated. Therapeutically it has proven useful in the reconstruction of the articular surface and in the treatment of chondral, intrinsic carpal and TFCC injuries. Results here have been generally comparable to established managements.
Immunology of trauma
Authors: Cook Matthew C
Published: January 2007

Systemic inflammation involves a large number of mediators and effector mechanisms. One approach to understanding systemic inflammation is to interpret the nature of the response based on the effector mechanisms that are observed. An alternative approach is to consider these effector responses in the context of our current understanding of immunoregulation. The aim of this article is to provide an overview of the immune response and discuss the mechanisms of immunoregulation in order to provide non-immunologists with a framework for understanding the normal and aberrant immune responses that can be precipitated by major trauma. The clinical manifestations of the inflammatory response to major trauma resemble those observed after other significant insults (surgery, burns, and pancreatitis). Furthermore, the clinical manifestations, changes in serum proteins, and pattern of immune activation point to the presence of infection, yet proof of a contribution by infection to the pathogenesis by infection remains elusive. Although inflammation dominates the early phase of the response, there is often evidence of a paradoxical combination of inflammation and immunosuppression later on. Consideration of the proinflammatory cascades, and the contribution of the innate immune system, helps explain why the clinical picture after major trauma may resemble other clinical states. It also explains the counter-regulatory response, which normally acts to downregulate inflammation, but may cause immunosuppression in the face of persistent inflammation after major trauma.
Non-operative management of solid organ trauma in children
Authors: Powis MR , Cord-Udy C , Walsh M
Published: January 2007

Trauma is the commonest cause of mortality in infancy and childhood. Injuries from blunt trauma predominate, with multisystem injury, the rule. Blunt abdominal injury represents the third commonest cause of death from injury in this age group.

Initial management of the child combines assessment and resuscitation. If the child’s condition is stable then the injured organ should be definitively identified, usually by computerized tomography. Over 90% of children who are stable at this point can be managed conservatively, with a period of observation on an intensive care unit, followed by bed rest on a general ward. Instability at any point requires further resuscitation, reassessment and if necessary laparotomy. Repeated clinical assessment and radiological investigation are used to guide further management, mobilization and the return to normal activities.
Thoracoscopy in chest trauma: an update
Authors: Leppäniemi Ari K
Published: January 2007

The role of thoracoscopy in the management of patients with chest injuries is constantly being redefined as more reports on its use continue to emerge in the literature. As of today video-thoracoscopy has been used mainly as a diagnostic tool for certain occult injuries, such as of the diaphragm, as well as a minimally invasive management option in specific therapeutic situations including early evacuation of retained thoracic collections. It has the potential to replace open surgery in the management of more than 50% of civilian and military thoracic injuries previously considered candidates for open surgical management with all the benefits of minimally invasive surgery. In addition, it is a promising tool for earlier detection of missed injuries in patients otherwise managed nonoperatively. The procedure-related complication rate is low and there are only few contraindications for thoracoscopy, mainly haemodynamic instability and obliterated pleural space caused by previous infections or surgical interventions. However, the scientific evaluation of the global impact of thoracoscopy in the management of thoracic injuries is currently limited to descriptive series, some of them using historical controls, and a few non-randomized prospective studies. Until more well-designed, prospective, randomized studies emerge which compare thoracoscopy to standard management protocols in defined patient populations with thoracic injuries using relevant end points, the potential benefit of thoracoscopy in chest trauma remains unvalidated and its value is limited to isolated patients depending on individual surgeon’s preferences and skills.
Which fluid to give?
Authors: Protheroe Richard , Nolan Jerry
Published: January 2007

Crystalloids are generally accepted, as the initial fluid of choice during trauma patient resuscitation but the pragmatic approach is to give a combination of both crystalloid and colloid. Plasmalyte 148 has advantages over both saline and lactated Ringer’s. Medium-or low-molecular weight hydroxyethyl starch may be the colloid of choice. In the future, haemoglobin-based oxygen carriers are likely to play a prominent role in trauma resuscitation.
High-tension electrical burns: special problems and their management
Authors: Duncan C , Aiyer P , Peart F
Published: January 2007

High tension burn injuries comprise 1% of admissions to burns units and have a high incidence of mortality or amputation of an extremity in patients who survive. A dichotomy regarding treatment rationale for high tension electrically injured patients exists and is supported by two separate views of the pathophysiology of the injury. One view contends that the full extent of the injury occurs at the time of injury and this concept is used to support a philosophy of early radical debridement and reconstruction. Another view is that an element of chronicity exists in wound development and that serial examinations and debridements may be required prior to definitive reconstruction. The treatment rationale presented by the authors is that the high complication rate associated with these injuries, including partial or complete flap failure, as well as the need to preserve vital tissue justifies a cautious reconstructive approach similar to that used in high velocity lower limb injuries with serial examinations and debridements taking place prior to definitive reconstruction. A historical overview and discussion of some of the unique features of high tension electrical injuries is presented and used to support the authors’ philosophy of management.
Cartilage culture
Authors: Taylor Joanne , Richardson James
Published: January 2007

Defects in the articular cartilage can cause severe pain and may lead to marked disability with loss of both physical and social functioning. The majority of patients are young and in employment prior to their injury. Cartilage injury also occurs more frequently than one might expect, therefore it is important to find a method of treating these patients, who are clearly too young to consider arthroplasty. Advances in tissue engineering have allowed the development of new techniques, such as Autologous Chondrocyte Implantation (ACI), for dealing with articular cartilage defects. ACI is the treatment of an articular cartilage defect using cells taken from a healthy part of a joint, which are grown in a laboratory and re-implanted into the defect. It is a two-stage procedure involving an arthroscopic cell harvest and an arthrotomy as a second procedure three weeks later. In our series, 80% of patients with isolated femoral condylar defects report an improvement in their functional knee scores one year postoperatively. It is likely that further developments in tissue engineering will provide the ability to treat osteoarthritic defects in younger patients by methods very similar to ACI. Thus, in the future an even wider range of patients will benefit from cartilage transplantation
Anterior cruciate ligament rupture and management
Authors: Bowditch Mark
Published: January 2007

Anterior cruciate ligament rupture is a common knee injury in young people. It is the commonest cause of an acute haemarthrosis following trauma. Acute management involves aspiration, the restoration of full movement, followed by muscle rehabilitation. The long-term natural history of non-operative management is usually a failure to return to high level sports and in most, symptomatic instability with secondary meniscal and chondral injury. The late outcome is that of premature degenerative arthritis. Reconstructive techniques are now advanced and minimally invasive. However, considerable technical skill and experience is required to avoid complications. Physiotherapy guided rehabilitation over 4-6 months is vital prior to a return to sport. The stabilised knee should reduce secondary injury and progressive degenerative disease. In the future an increased number of reconstructions, tissue engineered grafts and accelerated healing will probably be seen.
Prevention and treatment of venous thromboembolism after major trauma
Authors: Verstraete Marc
Published: January 2007

In prospective studies the incidence of deep venous thrombosis, documented by venography, is between 35% and 63% in patients with major trauma. Five independent risk factors for deep vein thrombosis have been identified in these patients: older age, fracture of the femur or tibia, surgery, spinal cord injury and blood transfusion. Mechanical antithrombotic methods and low-dose unfractionated heparin administered subcutaneously moderately decrease the risk of venous thromboembolism but are less effective than a fixed dose of subcutaneous unmonitored low molecular weight heparin. Prophylaxis with oral anticoagulants (International Normalized Ratio 2.0-3.0) is also effective but is much less used because of the bleeding risk. This is particularly the case in patients with intracranial neurosurgery and acute spinal cord injury. Only a few clinical studies have evaluated the treatment of venous thromboembolism in patients with major trauma. If the condition of a patient with major injury allows, the treatment of venous thromboembolism recommended after hip replacement is cautiously applied.
Current technology: laparoscopic surgery in trauma
Authors: Brooks Adam J , Boffard Ken D
Published: January 2007

There has been a rapid increase in the use of laparoscopy in general surgery over recent years. However in the field of trauma its role has not been defined and its regular use remains limited to a select group of enthusiasts. We present a review of the current literature on laparoscopic surgery in trauma including therapeutic procedures and a brief synopsis of the alternative methods of investigation for abdominal injury, and our interpretation of the current role of laparoscopic surgery in trauma today.
Brain monitoring in severe head injury: a practical guide
Authors: Mathew P , Gentleman D , Bullock MR
Published: January 2007

There is, as yet, no specific therapy available for post-traumatic brain damage; the treatment of head injury is therefore aimed at limitation of secondary damage at the cellular, whole organ and systemic level.

The purpose of monitoring the injured brain is twofold:

1. to obtain a better understanding of the mechanisms by which pathophysiological processes further damage the injured brain

2. to continuously detect potentially harmful influences and allow them to be reversed before damage is done.

In this review, we provide a general overview of mechanisms of brain damage due to high intracranial pressure (ICP) and discuss the following ‘brain specific’ haemodynamic monitoring techniques:

• ICP/CPP (cerebral perfusion pressure) monitoring;

• jugular vein saturation (SjO2) monitoring;

• cerebral oxygen monitoring (PtiO2) and near infra-red spectroscopy (NIRS);

• brain temperature monitoring;

• cerebral blood flow (CBF) monitoring; and

• transcranial Doppler.

We also discuss the role of functional techniques such as electroencephalogram (EEG) and evoked potential monitoring. This article gives an overview of the techniques currently available in a rapidly expanding field within neuro-intensive care, mainly for the interest of trauma surgeons, intensivists, and others with a practical need to understand the monitoring of the injured brain.
Crystalloids and colloids for volume replacement
Authors: Sutcliffe Anne J
Published: January 2007

For many years there has been a debate about whether crystalloids or colloids should be used for resuscitation. Some years ago, albumin was the gold standard against which all other solutions were compared. This continues to be the case, despite the fact that other solutions are as effective for volume replacement. This paper stresses the need for a proper understanding of the properties of solutions that may influence the choice for volume replacement. Different classes of solutions are discussed in detail, with special reference to their effects on cardiovascular and oxygen transport parameters. Other important properties such as side-effects and effect on coagulation are also considered.
Controversies in advanced trauma life support
Authors: Driscoll P , Gwinnutt C , McNeill I
Published: January 2007

Since its introduction to the UK in 1988, the Advanced Trauma Life Support (ATLS) course has become the accepted standard for the care of victims of trauma during the ‘golden hour’. Yet despite this success, ATLS has been criticized over the years for its philosophy, the course contents, the rigid regulations, cost to participants and lack of validation. The aim of this article is to explore these and other frequently voiced concerns in the light of evidence gathered over the 20 years since ATLS was first introduced in the USA.
When to ventilate
Authors: Wright Sue
Published: January 2007

Within the setting of trauma, there are many indications for intubation and ventilation, but the ultimate aims are always the same. These are to ensure airway patency and security, provide an acceptable level of arterial oxygenation at the lowest possible inspired oxygen concentration, control arterial carbon dioxide tension and optimize pulmonary and systemic blood flow.

The clinical situation, developing trends, and the experience of the individual concerned will all influence the decision to intubate and ventilate the patient who has suffered trauma. This paper considers the ‘rule-of-thumb’ indications for intubation in the emergency room and discusses the factors which may influence their interpretation.
Trauma in pregnancy
Authors: Brown Ruth
Published: January 2007

Serious trauma in pregnancy is an uncommon event but is particularly challenging to the physician, due to the presence of a potential second patient. Responding to the challenge requires a knowledge of the physiological changes which may alter the maternal response to injury, as well as an understanding of the maternal-fetal relationship. Fetal outcome is dependent on maternal well-being, and thus timely and appropriate resuscitation of the mother is the first priority. Initial management of the pregnant trauma patient includes attention to the airway-breathing-circulation (ABC). Certain injuries are more common in pregnancy and are influenced by the presence of the gravid uterus. The physician needs an awareness of the common complications of pregnancy and additional skills may be required to diagnose and assess fetal viability. The principles of the perimortem section should be understood, as well as the social implications of domestic violence towards pregnant women.
Medical care in civil disorder
Authors: Cocks Robert A
Published: January 2007

Civil disorder may be defined in widely differing terms, depending largely on the political and legal system prevailing in a given country. The way in which the authorities manage disorder has important implications for both internal stability and the country’s international image, and to a great extent the number of injuries will also depend on the effectiveness of this management.

For the police, ambulance service and hospitals, civil disorder will often necessitate the invocation of their respective major incident plans. Since the response requirements may be very different from other disasters, such plans need to address civil disorder specifically.

This paper reviews the various wounding agents that may be used by participants in civil disorder, and by security forces in their response. The issues of personal safety for emergency service staff are reviewed, and the organizational aspects of medical care emphasized.
Pitfalls in the management of the trauma patient in the intensive care unit
Authors: Angle Niren , Coimbra Raul , Hoyt David B
Published: January 2007

The management of the critically injured patient in the intensive care unit is the focus of this paper, in particular, the pitfalls attendant in the diagnosis and treatment of specific injuries. The past two decades have seen great advances in the care of the injured patient, both in the prehospital triage and transport and in the intensive care unit. More than ever, the outcome of these patients, both in terms of morbidity and mortality, is very dependent on a solid understanding of the pathophysiology of certain disease states and also of the evolution of certain injuries. Attention to detail is critical and an awareness of the pitfalls is essential, if one is to be successful in avoiding preventable morbidity and mortality. This article addresses pitfalls in judgement and also in specific management of specific injury patterns that will aid in better management of the severely injured patient.
Internationalism in the invisible college
Authors: Díaz-Andreu Margarita
Published: January 2007

This article analyses the effect that ideology may have in the relationships established between archaeologists of opposing political persuasions. It is argued that modern historiographers’ assumption that archaeologists holding different ideologies could not possibly support each other needs urgent revision. It is proposed that, for the decades immediately before and after World War II, the disregard of the political aspect when dealing with colleagues can partly be explained by the widely held belief in the absolute value of science, especially at a time when, in the case of prehistoric archaeology, the discipline was being professionalized. In this article the links established between prehistoric archaeologists of opposing political ideologies is framed within the discussion of invisible colleges, the professional networks which form unofficial power bases within academia. It is suggested not only that they seem to be more interested in the control of academic resources than in political convictions, but that invisible colleges also operate at an international level. Thus, invisible colleges in each country may be linked with others elsewhere, even when their members live under completely different political regimes. As the basis for the discussion this article uses the correspondence between three prehistoric archaeologists: the Marxist Gordon Childe (1892-1957), the Francoist Lluís Pericot (1899-1978) and, to a lesser extent, the Falangist (i.e. Spanish Fascist) Julio Martínez Santa-Olalla (1905-72).
Metals in society
Authors: Chirikure Shadreck
Published: January 2007

Indigenous iron working has received considerable attention from Africanist archaeologists but its contribution to the evolution of political process has never attracted serious interest in southern Africa. In this article, comparative historical and archaeological data presented suggest that specialist iron working was linked with the configuration and reconfiguration of political and economic systems. This is because iron was produced within a worldview and the ideological and symbolic meanings attached to its production and use sometimes fashioned opportunities through which power was created, negotiated and institutionalized. A number of examples from southern Africa are discussed and serve to illustrate these points.
Contextual issues in Paleoindian repatriation
Authors: Edgar Heather J.H. , Jolie Edward A. , Powell Joseph F. , Watkins Joe E.
Published: January 2007

Judge John Jelderks found that Kennewick Man cannot be defined as Native American under the Native American Graves Protection and Repatriation Act. A recent amicus brief in the legal case regarding repatriation of materials from Spirit Cave, Nevada, suggests that the Kennewick case should be used as legal precedent, and that the remains of Spirit Cave Man are also not Native American. We suggest that a precedent in cases of Paleoindian human remains is inappropriate and unnecessary. We provide bioarchaeological, human variation, archaeological, social, and cultural contexts of the Spirit Cave Man remains. These contexts indicate that this case, and likely all of the few Paleoindian cases, is unique. Determinations of repatriation of Paleoindians should be handled on a case-by-case basis.
Rock art and social life
Authors: Fairén-Jiménez Sara
Published: January 2007

This article revisits the Neolithic transition in Mediterranean Iberia taking into account an aspect usually neglected in the archaeological discourse: the rock art styles that emerged in this context. These distinct styles have been generally attributed to different populations, according to a historicist point of view that equates stylistic variability and ethnic identity. However, the recent recognition that they were developed by the same social group requires the formulation of an alternative explanation. My proposal is based on the exploration of the social context of production and consumption of the rock art, through the analysis of the patterns of location of the sites within the landscape and the definition of their archaeological context.
Enhancing Student Employability?
Authors: Brown Ralph
Published: January 2007

PALATINE, the Higher Education Academy Subject Centre for Dance, Drama and Music, received dedicated HEFCE funding (2003-2004) to address issues surrounding graduate employability, particularly focusing on the distinctive features of the labour market in the performing arts and creative industries. In the world of the Arts, the job market is very competitive and employment prospects for graduates are relatively uncertain. Career paths in this field are also very different from traditional career models in other industries. Despite the fact that performing arts courses have been listed at the lowest end of university league tables for graduate employment, this article demonstrates that courses in dance, drama and music are generally providing excellent preparation for the demands of the creative industries.
The History of the English Language Course
Authors: Dressman Michael R.
Published: January 2007

The study of the history of the English language can help students become aware of major issues in several academic fields, including history, literature, political science, anthropology, communication, economics, the Arts, and, of course, languages and linguistics. Even though instructors may not have an especially broad background in the Humanities, the students themselves bring their own set of interests to the course. The students’ curiosity for their already existing interests can be exploited to broaden the course and to help them see connections between methodologies and subjects. With carefully designed assignments - perhaps using the assistance of colleagues in other fields - an instructor can make a course in the history of the English language a catalyst for learning in a variety of academic areas.
Decisions of an Alarmingly Personal Nature, or, What I Think About William Wordsworth
Authors: Abbott Ruth
Published: January 2007

This article begins by noting the tendency of certain academic practices to arrest thought, and attempts to circumvent that arrestation in the writer by reflecting on her adolescent response to the writings of William Wordsworth. It explores the possible implications of a youthful feeling that poetry is ‘true’, tying this in with Wordsworth’s own writing about poetry and truth, and with a particular passage from Wordsworth’s Home at Grasmere which once prompted that youthful feeling. The personal and particular sources from which affective responses to poetry are often drawn are noted, and prosody is put forward as one of the most important among these sources, firstly for the present writer and then for Wordsworth himself. It finishes by contemplating the loss of that youthful response to poetry, and the implications of that loss for thinking.
what is appropriate mathematics education for four-year-olds?
Authors: Lee Joon Sun , Ginsburg Herbert P.
Published: January 2007

This study explored pre-kindergarten teachers' beliefs about the appropriateness of early mathematics education. Thirty pre-kindergarten teachers of four-year-olds, half working with low-SES children at publicly funded pre-kindergartens and the other half with middle-SES children at private pre-kindergartens, were interviewed concerning written vignettes describing two fictitious pre-kindergarten teachers' contrasting pedagogies concerning key issues in teaching mathematics to young children. The low-SES publicly funded pre-kindergarten teachers tended to support a strong focus on goal-based mathematics teaching at pre-kindergarten and at home to get children ready for kindergarten. The middle-SES private pre-kindergarten teachers tended to endorse flexible mathematics education relying on a child-centered curriculum and child-initiated learning and to oppose the instructional use of computers. Both groups, however, were similarly likely to mention that with increased academic demands, pre-kindergarten teachers needed to provide mathematics education, especially in simple arithmetic, albeit in a fun manner, without triggering stress or anxiety. These findings have significant implications for professional development.