RESUMEN
The Birmingham Burns Centre has been regularly presenting its mortality estimates since its pioneering work in 1949 on the use of probit analysis. The last of these estimates that showed a significant improvement in survival was presented in 1971. This improvement was attributed to the introduction of topical 0.5% silver nitrate against Pseudomonas aeruginosa. In the last 20 years, several changes in management of burns have taken place following a better knowledge of its pathophysiology. This study shows our experience from the last 20 years by comparing mortality estimates between two successive 10-year periods i.e., 1979-1988 and 1989-1998. We used probit analysis for deriving lethal area 50 (LA 50) for various age groups. The comparison showed that the mortality curves between the two periods were identical suggesting no improvement in the chances of survival. Since the mortalities were so similar the data were combined. The LA 50s derived from this combined data when compared with our earlier series from 1965 to 1970 also did not show a significant change in mortality. We conclude that in our experience the chances of dying for a given severity of injury have not changed significantly for more than 20 years.
Asunto(s)
Antiinfecciosos Locales/uso terapéutico , Quemaduras/tratamiento farmacológico , Quemaduras/mortalidad , Infecciones por Pseudomonas/tratamiento farmacológico , Nitrato de Plata/uso terapéutico , Adolescente , Adulto , Anciano , Unidades de Quemados/estadística & datos numéricos , Quemaduras/complicaciones , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Infecciones por Pseudomonas/etiología , Pseudomonas aeruginosa/aislamiento & purificación , Tasa de Supervivencia , Índices de Gravedad del Trauma , Reino Unido/epidemiologíaRESUMEN
Successful cytogenetic analysis was performed on tumor material from 26 patients with resectable colorectal cancer. 9 women and 17 men, aged 43 to 92 years, median 67 years. Clonal anomalies were found in twenty patients; five tumors showed mainly slight numerical changes such as trisomy 7 and loss of Y (2 cases). The remaining 15 tumors had highly complex karyotypes. The mainline was near diploid in six cases (5/6 tumors of the proximal colon), near triploid in four and near tetraploid in five tumors. Loss of chromosomes was most frequently observed with chromosomes 2, 5, 18, 20, and Y, the most frequently gained chromosomes were 7, 8, 13, 15, and X. Structural aberrations affected all chromosomes, except Y. The most frequently rearranged bands were 5q21, 7p15, 9p21, 13q11, 16p12, 17p13, 18q21, 21q11. Anomalies of chromosomes 5, 17, and 18 occurred concomitantly in 9/20 patients. All patients with deletions of 17p (n = 6) had near tetraploid karyotypes with high cell to cell variability and a median of nine structural aberrations (p < 0.007); four of them presented with parenchymal metastases at the time of surgery. Tumors of the proximal part of colon were with one exception diploid or near diploid, but no specific pattern of aberrations was detectable. However, it appears noteworthy that of the six patients with tumors of the ascending colon, three tumors had deletions at 16p12 and the affected patients had a short duration of survival. The tumor karyotypes of patients with parenchymal metastases revealed a trend to greater complexity of numerical and structural aberrations. Changes involving 8p22 or loss of chromosomes 8 were found in tumors of all parts of the colon and potentially associated with an unfavorable prognosis (4/7 decreased patients showed such changes).
Asunto(s)
Transformación Celular Neoplásica/genética , Aberraciones Cromosómicas , Neoplasias Colorrectales/genética , Adulto , Anciano , Anciano de 80 o más Años , Transformación Celular Neoplásica/patología , Colon/patología , Neoplasias Colorrectales/patología , Femenino , Humanos , Cariotipificación , Masculino , Persona de Mediana Edad , Pronóstico , Recto/patologíaAsunto(s)
Accidentes de Tránsito , Envejecimiento , Conducción de Automóvil , Humanos , Competencia Mental , Aptitud FísicaRESUMEN
Both the TRISS and ISS/Age methods have been used to assess the mortality results in a series of injured patients. Though observed survival was not significantly different from that expected using TRISS, the method seemed to place too great an emphasis on the initial clinical signs summarized in the RTS. In particular, early cardiovascular signs can be variable and misleading. The TRISS calculation also seems to make inadequate allowance for age effects in the elderly. The simpler ISS/Age method is free from these difficulties and with further development and a more up-to-date base series might become a better basis for overall survival estimates.
Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Índices de Gravedad del Trauma , Heridas y Lesiones/mortalidad , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Inglaterra , Humanos , Lactante , Recién Nacido , Puntaje de Gravedad del Traumatismo , Persona de Mediana Edad , Heridas no Penetrantes/mortalidad , Heridas Penetrantes/mortalidadRESUMEN
The North Report mentioned the question of whether charges and/or sentencing should be modified by fatal outcome following offences involving bad driving. This note classifies factors relating to the accident, the casualty and medical care which may, often fortuitously, determine a fatal outcome. It is suggested that these should be borne in mind in deciding offences and sentencing.
Asunto(s)
Accidentes de Tránsito/mortalidad , Accidentes de Tránsito/legislación & jurisprudencia , Accidentes de Tránsito/prevención & control , Atención Ambulatoria , Humanos , Percepción Social , Análisis de Supervivencia , Reino Unido , Heridas y Lesiones/etiología , Heridas y Lesiones/mortalidad , Heridas y Lesiones/terapiaRESUMEN
The value of modelling for the study of accidents and for devising and assessing methods of prevention depends on the reliability of data sources. Police statistics are commonly used for accidents which cause death or injury. Several studies, however, show their deficiencies particularly for injury accidents of pedestrians and pedal cyclists. Hospital records give better information on injuries and diagnostic classification by the ICD code can be usefully improved by inclusion of the "E" (circumstance) detail. Insurance data can provide another source which is likely to be best for accidents involving multiple vehicles and damage to the property of third parties. The special "no fault" compensation system in New Zealand gives an unusually full source of data suitable for statistical analysis of accidents.
Asunto(s)
Accidentes de Tránsito , Recolección de Datos , Modelos Teóricos , Europa (Continente) , Humanos , Seguro por Accidentes , Seguro de Responsabilidad Civil , Nueva Zelanda , Estadística como Asunto , Reino Unido , Estados UnidosRESUMEN
The disabilities incurred by 2502 road accident patients admitted in three separate years to an Accident Hospital have been analysed. There were about equal numbers of disabled among pedestrians, motorcyclists and vehicle occupants. This corresponds to the high relative frequency and severity of injuries among motorcyclists. Most of the serious disabilities were caused by head or lower limb injuries. Different severities of disability were not closely correlated with Abbreviated Injury Scale (AIS), (ISS) or (PI) scores or with treatment periods but useful threshold values are described which separate groups with high and low rates of disability. For given severities of injury, disabilities were less severe among young casualties. Comparisons with other studies show rather wide variations in estimates of the incidence of slight disabilities. There is fair agreement with the present findings that serious disabilities occur in about 3% of inpatient hospital cases or in about 1% of total casualties.
Asunto(s)
Accidentes de Tránsito , Personas con Discapacidad , Adolescente , Adulto , Factores de Edad , Anciano , Traumatismos de la Espalda , Lesiones Encefálicas/etiología , Niño , Preescolar , Contusiones/etiología , Traumatismos Craneocerebrales/etiología , Extremidades/lesiones , Femenino , Fracturas Cerradas/etiología , Humanos , Lactante , Recién Nacido , Pacientes Internos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Pelvis/lesiones , Probabilidad , Piel/lesiones , Traumatismos de la Médula Espinal/etiologíaAsunto(s)
Heridas y Lesiones/clasificación , Factores de Edad , Humanos , Métodos , Pronóstico , Riesgo , Heridas y Lesiones/mortalidadRESUMEN
Selected studies of road injury causation since 1960 are reviewed together with corresponding methods of prevention. British road accident deaths have remained relatively low in spite of greatly increased numbers of vehicles. Though not the only factors, improvements in car design and in safety equipment of vehicles have contributed to injury prevention.