RESUMEN
Microscopic examination was performed on 55 cases of traumatic liver lacerations incurred from fatal motor vehicle accidents. None of the deaths was due to the liver injury. In 38 of 55 cases, the decedent was pronounced dead at the scene. Microscopic examination of the liver lacerations in these 38 cases revealed no histologic changes related to the trauma. In 17 of 55 cases, the decedent was transported to the emergency room (ER) with a "survival time" (from Emergency Medical Service arrival to the time of pronouncement) of 15 minutes to 7 hours and 10 minutes. Nine of these 17 had vital signs at the scene. Five of the 17 had neutrophilic infiltration and hepatocyte necrosis at the site of the laceration. Four of these had vitals signs at the scene. Survival time of the 5 patients with a vital reaction at their liver injury ranged from 51 minutes to 7 hours and 10 minutes.
Asunto(s)
Laceraciones/patología , Hígado/lesiones , Hígado/patología , Accidentes de Tránsito , Arizona , Hígado Graso/patología , Patologia Forense , Hepatocitos/patología , Humanos , Cirrosis Hepática/patología , Microscopía , Necrosis , Neutrófilos/metabolismo , Estudios Prospectivos , Texas , Factores de TiempoRESUMEN
Generation of vinyl cations is facile by fragmentation of alkenyl(aryl)iodonium trifluoromethanesulfonates. Kinetics and electronic effects were probed by (1)H NMR spectroscopy in CDCl(3). Products of fragmentation include six enol triflate isomers in addition to iodoarenes. The enol triflates arise from direct reaction of a triflate anion with the starting iodonium salts as well as triflate reaction with rearranged secondary cations derived from those salts. G2 calculations of the theoretical isodesmic hydride-transfer reaction between secondary vinyl cation 7 and primary vinyl cation 6 reveal that cation 6 is 17.8 kcal/mol higher in energy. Activation parameters for fragmentation of (Z)-2-ethyl-1-hexenyl(3,5-bis-trifluoromethylphenyl)iodonium triflate, 17e, were calculated using the Arrhenius equation: E(a) = 26.8 kcal/mol, Delta H(++) = 26.2 kcal/mol, and Delta S(++) = 11.9 cal/mol x K. Added triflate increases the rate of fragmentation slightly, and it is likely that for most beta,beta-dialkyl- substituted vinylic iodonium triflates enol triflate fragmentation products are derived from three competing mechanisms: (a) vinylic S(N)()2 substitution; (b) ligand coupling (LC); and (c) concerted aryliodonio departure and 1,2-alkyl shift leading to secondary rather than primary vinyl cations.
RESUMEN
CONTEXT: Clostridium septicum infections are rare but often associated with serious if not fatal outcomes. Clostridium septicum infection does not appear to be associated with a single specific defect in cellular or humoral immunity. It has been associated with multiple medical problems, including but not limited to leukemia, malignancy of the bowel, other solid tumors, cyclic neutropenia with enterocolitis, diabetes mellitus, and severe arteriosclerosis. Most cases of C septicum are associated with malignancy, and mortality approaches 100% if care is not rendered within 12 to 24 hours. OBJECTIVES: To evaluate outcomes of patients with C septicum bacteremia, whether treated medically or surgically or both, and to note associated conditions. DESIGN: Retrospective evaluation of patients found to have C septicum bacteremia in the past 6 years. SETTING: Two teaching hospitals, Brooke Army Medical Center (250 beds) and Wilford Hall Medical Center (292 beds), were the source of our patients. PATIENTS: All patients found to have C septicum bacteremia during hospitalization or postmortem examination were included in the study. There were no exclusion criteria. MAIN OUTCOME MEASURE: Mortality associated with C septicum infection. RESULTS: In our case series, mortality was 33%, which is slightly lower than reported in prior studies (43%-70%). CONCLUSION: Presumptive identification based on Gram stain, awareness of C septicum infection as a paraneoplastic syndrome, and prompt, clear communication between laboratory personnel and clinicians are necessary for early diagnosis of C septicum infection. Early institution of antibiotic therapy improves prognosis.