摘要:

To study the potential differences that distinguish homicides involving women as victims or offenders from those involving men, we analyzed Federal Bureau of Investigation Uniform Crime Reports data on homicides that occurred in the United States between 1976 and 1987. Only cases that involved victims aged 15 years or older were included. Persons killed during law enforcement activity and cases in which the victim's gender was not recorded were excluded. A total of 215,273 homicides were studied, 77% of which involved male victims and 23% female victims. Although the overall risk of homicide for women was substantially lower than that of men (rate ratio [RR] = 0.27), their risk of being killed by a spouse or intimate acquaintance was higher (RR = 1.23). In contrast to men, the killing of a woman by a stranger was rare (RR = 0.18). More than twice as many women were shot and killed by their husband or intimate acquaintance than were murdered by strangers using guns, knives, or any other means. Although women comprise more than half the U.S. population, they committed only 14.7% of the homicides noted during the study interval. In contrast to men, who killed nonintimate acquaintances, strangers, or victims of undetermined relationship in 80% of cases, women killed their spouse, an intimate acquaintance, or a family member in 60% of cases. When men killed with a gun, they most commonly shot a stranger or a non-family acquaintance. When women killed with a gun, the victim was five times more likely to be their spouse, an intimate acquaintance, or a member of their family than to be a stranger or a person of undetermined relationship.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The controversy over a policy of “scoop and run” or stabilizing hemorrhagic shock when evacuation time is short has not yet been settled. Small volumes of hypertonic saline have been suggested as effective therapy when the scoop-and-run policy is adopted. In the present study small-volume hypertonic saline treatment and normal saline treatment of “uncontrolled” hemorrhagic shock (UCHS) in rats were compared with no treatment, which best simulates the scoop-and-run policy. The rats were randomly assigned to three groups. Uncontrolled hemorrhagic shock was induced by 12% resection of the terminal portion of the rats' tails. In group I (n = 13) the animals were untreated. In group II (n = 6) UCHS was treated by administering 41.5 mL/kg 0.9% NaCl (NS). In group III (n = 6) UCHS was treated by administering 5 mL/kg 7.5% NaCl (HTS). Resection of the rats' tails in group I was followed by bleeding of 3.3 ± 0.3 mL in 15 minutes with a fall in mean arterial pressure (MAP) from 100.9 ± 7 to 63.5 ± 5 mm Hg (p < 0.001). The early bleeding and hemodynamic responses were similar in all three groups. Further blood loss in the first hour in group I was 0.5 ± 0.2 mL, and MAP rose spontaneously to 73.2 ± 6 mm Hg (p< 0.05). The NS infusion in group II was followed by further bleeding of 4.1 ± 0.9 mL (p< 0.01) and a further fall in MAP to 53.8 ± 7 mm Hg (p< 0.01) after 60 minutes. Small-volume HTS infusion in group III was followed by further bleeding of 6.5 ± 1.0 mL (p< 0.01) and a fall in MAP to 27.6 ± 7 mm Hg (p< 0.005) after 60 minutes. Thirty-one percent of the animals in group I and 33% of the rats in group II died. All animals in group III were dead after 2 hours (p< 0.01). It is concluded that small-volume HTS infusion in uncontrolled hemorrhagic shock led to increased early bleeding, rapid hemodynamic deterioration, and increased mortality. Infusion of normal saline led to increased bleeding and hemodynamic instability but no increased mortality. The animals with no treatment, which best simulates the scoop-and-run policy, were hemodynamically most stable with minimal blood loss.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We reviewed the records of 1538 mild head injury patients admitted during a 4½-year period to the Southern New Jersey Regional Trauma Center. All patients had experienced brief loss of consciousness or amnesia, but had a normal or near normal neurologic examination on admission, with Glasgow Coma Scale (GCS) scores of 13–15 and no focal neurologic deficit. Routine urgent cranial CT scans were obtained on all patients, and correlations between skull fractures and intracranial lesions investigated. Two hundred sixty-five patients (17.2%) harbored 340 lesions on CT scans, of which 131 were fractures and 209 were intracranial abnormalities. Fifty-eight patients needed surgery for their intracranial lesions; 23 of them had no skull fractures. None of the 1339 patients without CT evidence of intracranial lesions deteriorated under observation. We conclude that clinical observation with or without skull x-ray films is inadequate to rule out potentially dangerous intracranial lesions in apparently mild head injuries. If there is a history of loss of consciousness or amnesia, an immediate CT scan is indicated. If the results of the CT scan are normal and there are no other indications for admission, these patients may be safely discharged.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

To determine the effect of copper in tissue, copper specimens, along with other metals commonly used in firearm projectiles, were implanted into rats. Copper consistently produced a necrotic, abscesslike reaction in all tissues tested. Nickel produced a similar reaction, although of lesser magnitude. Aluminum, zinc, and lead produced no significant tissue reaction.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Multivariate analysis was used to identify factors predicting injury and visual outcome in 94 blunt trauma patients evaluated for eye injuries among 6700 admissions to a level I trauma center over a 29-month period. Patients with penetrating eye injuries were excluded from this review. Eye injury was detected in 93% or 87 of the patients evaluated. Seven percent of eye injuries resulted in blindness, 22% were serious (visual acuity between 20/40 and 20/200 or eye injury requiring surgery), and 71% were temporary (final visual acuity of 20/40 or better). The presence of an afferent pupillary defect or a nonreactive pupil was the most important factor in predicting the severity of eye injury (p= 0.0023), followed by facial fractures (p= 0.0084), and no eye opening or eye opening to pain within the Glasgow Coma Scale (p= 0.02). Eye injury is an infrequent complication of blunt trauma. Appropriate consultation for evaluation of this problem can be obtained based on findings from the initial history and screening physical examination.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

In order to demonstrate that the evolution of cardiac tamponade from a ventricular wound is different from that without myocardial wounding, the effects of a rapid infusion of saline solution on hemodynamic behavior and pericardial pressure (PP) were evaluated in dogs with cardiac tamponade caused by ventricular perforation (group C), animals without cardiac tamponade (group A), and animals with cardiac tamponade induced by infusion of saline into the pericardium (group B). We found that blood pressure (BP) increased from 107.5 ± 15.5 mm Hg to 126 ± 4 mm Hg in group A; increased from 64.5 ± 17.9 mm Hg to 117.5 ± 22.17 mm Hg in group B; and increased from 60.75 ± 46.5 mm Hg to 76 ± 14.4 mm Hg in group C. Central venous pressure (CVP) increased from 3.75 ± 0.96 cm H2O to 9.5 ± 3.3 cm H2O in group A; increased from 8 ± 2.4 cm H2O to 16.25 ± 3.1 cm H2O in group B; and rose from 7.75 ± 2.6 cm H2O to 20.66 ± 5.03 cm H2O in group C. Cardiac output (CO) increased from 3.9 ± 1.2 L/min to 18.93 ± 3.96 L/min in group A; increased from 1.23 ± 0.3 L/min to 5.4 ± 1.7 L/min in group B; and increased from 1.8 ± 0.66 L/min to 3.53 ± 1.31 L/min in group C. Pericardial pressure (PP) did not vary from 0 mm Hg in group A; increased from 9 ± 2.2 mm Hg to 14.25 ± 2.6 mm Hg in group B; and rose from 7.75 ± 2.06 mm Hg to 18.8 ± 4.24 mm Hg in group C. It is concluded that the evolution of cardiac tamponade with and without a myocardial wound during rapid infusion of saline solution is different.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The purpose of this study was to utilize a large population-based data base to determine the association of trauma centers with per capita county trauma death rates. Methods: Per capita county trauma death rate, the dependent variable in the model, was obtained from a well-validated state Medical Examiner's data base. Over 200 county demographic, prehospital, and hospital trauma care resource variables were obtained from a variety of sources for multivariate modeling. Bivariate analysis identified candidate variables for multivariate modeling, excluding highly correlated independent variables to avoid problems of collinearity. Multivariate linear regression, logistic regression, and stepwise discriminant analysis were used to determine the relative association of the candidate variables with per capita county trauma death rates. Results: Bivariate analysis identified multiple factors associated with per capita county trauma death rates. These included, among others: county rurality, percentage of unemployment, percentage nonwhite, 911 access, and ALS certified EMS. Per capita trauma death rates were significantly lower in counties with trauma centers compared with counties without trauma centers (4.0 ± 0.5 and 5.0 ± 1.1 deaths per 10,000 population,p= 0.0001, respectively). Multivariate analysis demonstrated that the presence of a trauma center in the county and ALS were the best medical system factors predicting decreased per capita county trauma death rates. Conclusions: This study is unique in utilizing a regional population-based data base of all trauma deaths in a large state to analyze the association of trauma centers and trauma death rates. Multivariate modeling controlling for other county variables demonstrated that the presence of a trauma center and Advanced Life Support training were the best predictors of per capita county trauma death rates. These findings are consistent with the hypothesis that trauma centers decrease trauma death rates.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Evaluation of blunt abdominal trauma is clinically challenging. Diagnostic peritoneal lavage (DPL) and computed tomographic (CT) scanning have become primary diagnostic modalities. We examined the efficacy and role of ultrasonographic (US) studies in the initial abdominal evaluation of blunt trauma patients. Over an 8-month period, patients whose abdominal work-up indicated the need for DPL or CT were evaluated sonographically within the first hour after admission by trauma fellows (PGY-6) with at least 1 hour of theoretical training and 1 hour of practical training. Sonograms considered positive were those showing free peritoneal fluid or organ disruption. Hard copies of the sonograms were evaluated by a staff radiologist without knowledge of the fellows' interpretations or of DPL or CT results. Based on the fellows' interpretation of the real-time sonograms, among the first 163 patients studied were 11 true-positive, 146 true-negative, one false-positive, and five false-negative results. Sixteen patients had intra-abdominal injury documented by DPL, CT, or laparotomy. Ultrasonography was 91% sensitive in detecting the presence of hemoperitoneum. Overall, ultrasonography was 69% sensitive, 99% specific, and 96% accurate in diagnosing abdominal injury. We conclude that emergency sonography on admission can serve as a valuable adjunct to the physical diagnosis of clinically significant hemoperitoneum. It is noninvasive, portable, and accurate in determining the need for further diagnostic/surgical intervention.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The effects of increased intra-abdominal pressure (IAP) on intestinal blood flow were studied in eight anesthetized pigs. Mesenteric artery blood flow (MABF), intestinal mucosal blood flow (IMBP), tonometric intramucosal pH (pH|), mean BP (MAP), cardiac output (CO), and pulmonary artery wedge pressure (PAWP) were measured as IAP was raised to 10, 20, 30, and 40 mm Hg by infusing lactated Ringer's solution (LR) into the peritoneal cavity. The MAP was kept constant with IV LR. Cardiac output fell slightly from 5.4 ± 1.1 at baseline to 4.0 ± 1.2 L/min at an IAP of 40 mm Hg (p< 0.05). An IAP of 20 mm Hg caused significant decreases in MABF (73% ± 22% of baseline) (p< 0.05) and IMBF (61% + 12% of baseline) (p< 0.05). These changes became progressively greater as the IAP was increased to 40 mm Hg. The pH> fell to 6.98 ± 0.14 at 40 mm Hg IAP (p< 0.01), indicating severe mucosal ischemia. Thus increased IAP can cause severe intestinal ischemia, which may be more important than the cardiac, pulmonary, and renal changes usually described.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID