Injury and alcohol: a hospital emergency department study

A pilot survey was undertaken of injury presentations to a public hospital emergency department to determine patterns of alcohol use in this population. Of the 402 injury presentations in the study period, a total of 236 injury cases were interviewed, of whom 45% (n=107) and 29% (n=69) had consumed alcohol 24 and 6 hours prior to injury. Mean age for all injury presentations was 35.1 years, and 32.6 years for alcohol injury cases. For both injury groups, males were significantly younger than females. Recent alcohol ingestion was three times more common among male than female injury presentations, but with females drinking at significantly lower levels. Of males who had consumed alcohol 6 hours prior to injury, nearly 70% were drinking at NHMRC harmful levels and 61% had drunk more than eight standard drinks. Overall, alcohol-involved injury cases commonly occurred among low-income, single males around 30 years of age who were regular heavy drinkers who were drinking heavily in licensed premises prior to their injury, and who sustained injury through intentional harm. In addition, one in five of the alcohol-involved injury cases were aged 15-18 years, i.e. below the legal age of purchase. The high proportion of hazardous and harmful drinkers among those who had consumed alcohol within the last 6 hours, and the injury sample overall, highlights the need for further research to explore the relationship between the occurrence of injury and the drinking patterns and environments associated with injury. Further research is also required to assess the efficacy of early and brief interventions for alcohol and drug use within the emergency ward setting. This information would enable appropriate public health interventions to be initiated.

Influence of deceleration profiles on occupant velocity differential and injury potential

This paper compares two hypothetical and identical vehicle deceleration profiles mirrored in time, one linearly descending with time and the other linearly ascending with time. The differences of such profiles on occupant velocity differential and by implication, injury levels at the point of occupant impact are presented. An indifference point is established to assist in comparing which occupant body part will benefit from the altered crash pulse. It is shown that for occupant proximity distances below the indifference point, an ascending profile results in lower injury risk. Above the indifference point, the result is reversed.

Determinants of death following burn injury

Background: Burn care has changed considerably. Early surgery, nutritional support, improved resuscitation and novel skin replacement techniques are now well established. The aim of the study was to establish whether changes in management have improved survival following burn injury and to determine the contributory factors leading to non-survival. Methods: This was a retrospective outcome analysis of data collected from a consecutive series of 4094 patients with burns admitted to a tertiary referral, metropolitan teaching hospital between 1972 and 1996, Results: The overall mortality rate was 3.6 per cent. This decreased from 5.3 per cent (1972-1980) to 3.4 per cent (1993-1996) (P = 0.076). The risk of death was increased with increasing burn size (relative risk (RR) 95.90 (95 per cent confidence interval 12.60-729.47) if more than 35 per cent of the total body surface area was burned; P < 0.001) increasing age (RR 7.32 (3.08-17.42) if aged more than 48 years; P < 0.001), inhalation injury (RR 3.61 (2.39-5.47); P < 0.001) and female sex (RR 1.82 (1.23-2.69); P = 0.003). Operative intervention (RR 0.11 (0.06-0.21); P < 0.001) and the presence of an upper limb burn (RR 0.53 (0.35-0.79); P = 0.002) decreased the risk. Conclusion: Modern burn care has decreased the mortality rate. Increasing burn size, increasing age, inhalation injury and female sex increased, while operative intervention and an upper limb burn decreased, the risk of death.

Relationship of glycosaminoglycan and matrix changes to vascular smooth cell phenotype modulation in rabbit arteries after acute injury

Purpose: The phenotype of vascular smooth muscle cells (SMCs) is altered in several arterial pathologies, including the neointima formed after acute arterial injury. This study examined the time course of this phenotypic change in relation to changes in the amount and distribution of matrix glycosaminoglycans. Methods: The immunochemical staining of heparan sulphates (HS) and chondroitin sulphates (CS) in the extracellular matrix of the arterial wall was examined at early points after balloon catheter injury of the rabbit carotid artery. SMC phenotype was assessed by means of ultrastructural morphometry of the cytoplasmic volume fraction of myofilaments. The proportions of cell and matrix components in the media were analyzed with similar morphometric techniques. Results: HS and CS were shown in close association with SMCs of the uninjured arterial media as well as being more widespread within the matrix. Within 6 hours after arterial injury, there was loss of the regular pericellular distribution of both HS and CS, which was associated with a significant expansion in the extracellular space. This preceded the change in ultrastructural phenotype of the SMCs. The glycosaminoglycan loss was most exaggerated at 4 days, after which time the HS and CS reappeared around the medial SMCs. SMCs of the recovering media were able to rapidly replace their glycosaminoglycans, whereas SMCs of the developing neointima failed to produce HS as readily as they produced CS. Conclusions: These studies indicate that changes in glycosaminoglycans of the extracellular matrix precede changes in SMC phenotype after acute arterial injury. In the recovering arterial media, SMCs replace their matrix glycosaminoglycans rapidly, whereas the newly established neointima fails to produce similar amounts of heparan sulphates.

A for stage III and IV squamous carcinoma of the head and neck: a Trans-Tasman Radiation Oncology Group Study

Purpose: The aims of this randomized controlled trial were to determine whether there were differences in the disease-free survival (DFS) and toxicity between conventional radiotherapy (CRT) and a continuous 3 week accelerated radiotherapy regimen (ART) in stage III and IV squamous cell carcinoma of the oral cavity, oropharynx, larynx and hypopharynx. Patients and methods: Patients from 14 centres throughout Australia and New Zealand were randomly assigned to either CRT, using a single 2 Gy/day to a dose of 70 Gy in 35 fractions in 49 days or to ART, using 1.8 Gy twice a day to a dose of 59.4 Gy in 33 fractions in 24 days. Treatment allocation was stratified for site and stage. The accrual began in 1991 and the trial was closed in 1998 when the target of 350 patients was reached. Results: The median potential follow-up time was 53 months (range, 14-101). The DFS at 5 years was 41% (95% CI, 33-50%) for ART and 35% (95% CI, 27-43%) for CRT (P = 0.323) and the hazard ratio was 0.87 in favour of ART (95% CI, 0.66-1.15). The 5-year disease-specific survival rates were 40% for CRT and 46% for ART (P = 0.398) and the loco-regional control was 47% for CRT vs. 52% for ART (P = 0.300). The respective hazard ratios were 0.88 (95% CI, 0.65-1.2) and 0.85 (0.62-1.16), favouring the accelerated arm. In the ART arm, confluent mucositis was more severe (94 vs. 71%; P < 0.001) and peaked about 3 weeks earlier than in the CRT arm, but healing appeared complete in all cases. There were statistically significant reductions in the probability of grade 2 or greater late soft tissue effects over time in the ART arm (P < 0.05), except for the mucous membrane where late effects were similar in both arms. Conclusions: Differences in DFS, disease-specific survival and loco-regional control have not been demonstrated. ART resulted in more acute mucosal toxicity, but this did not result in greater prolongation of the treatment time compared with the CRT arm. There were less late effects in the ART arm, with the exception of late mucosal effects. This trial has confirmed that tumour cell repopulation occurs during conventionally fractionated radiotherapy for head and neck cancer. However, it has also provided additional evidence that overall improvements in the therapeutic ratio using accelerated fractionation strategies are seriously constrained by the need to limit total doses to levels that do not exceed acute mucosal tolerance. The accelerated schedule tested has been shown in this trial to be an acceptable alternative to conventionally fractionated irradiation to 70 Gy. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.