Needle electrodes can be used for bispectral index monitoring of sedation in burn patients

IMPLICATIONS: We present the results of a study examining the agreement of bispectral index values obtained using original sensor and subdermal needle electrodes in burn patients. Both types of electrodes can be used interchangeably to monitor depth of sedation.     

Deaths: injuries, 2002.

OBJECTIVES: This report presents injury mortality data for 2002 using the external-cause-of-injury mortality matrix for the International Classification of Diseases, Tenth Revision (ICD-10). The external cause matrix is a detailed and comprehensive framework for tabulating and presenting injury deaths by mechanism and intent of death. Data are presented by age, sex, race, Hispanic origin, and State. In addition, trend data are shown for 1999-2002 by age, sex, and mechanism and intent of injury. This report also introduces the injury mortality diagnosis matrix. This latter is another framework that categorizes the nearly 1,200 injury diagnosis codes from ICD-10's chapter 19 according to body region and nature of the injury diagnosis information captured in the multiple-cause-of-death fields of the national mortality file. This report supplements the annual report of final mortality statistics. METHODS: Data in this report are based on information from all death certificates filed in the 50 States and the District of Columbia in 2002. Causes of death and nature of injury are processed and coded in accordance with the ICD-10. RESULTS: In 2002, 161,269 resident deaths occurred as the result of injuries. Of these injury deaths, 66.2 percent were classified as unintentional, 19.6 percent were suicides, 10.9 percent were homicides, 3.0 percent were of undetermined intent, and 0.3 percent involved legal intervention or operations of war. The five leading mechanisms of injury death were motor vehicle traffic, firearm, poisoning, falls, and suffocation, accounting for 81 percent of all injury deaths. The rate of poisoning deaths increased by 17.9 percent between 2001 and 2002, but the reader is advised to interpret these numbers cautiously as a portion of this increase is due to stricter procedures concerning data processing that were implemented in 2002. Thirty percent of injuries resulting in death were to the head and neck region with the vast majority of these classified as traumatic brain injury. Injuries involving the whole body system accounted for 28 percent of all injuries mentioned (17 percent were poisoning and 7 percent were other effects of external causes, such as submersion or asphyxiation). CONCLUSIONS: Injury mortality data presented in this report using the external cause-of-injury mortality matrix for ICD-10 provide detail on the mechanism of death needed for research and other activities related to injury prevention. This report highlights the importance of multiple causes-of-death data when analyzing injury mortality--special attention is given to the issue of accuracy and completeness of information as it pertains to these data. The Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS) is involved in several ongoing projects related to the study of injury and injury mortality.     

Metastatic Intracranial Chordoma in a Child with Massive Pulmonary Tumor Emboli

A 27-month-old boy of Hispanic background developed multiple cranial nerve palsies, difficulty swallowing, bloody nasal discharge, and irritability. Radiographic evaluations showed extensive destruction of the clivus by a large tumor that invaded the sphenoid bone, left cavernous sinus, ethmoid sinus, nasal cavity, and left orbit. Multiple pulmonary nodules were also noted. The bone marrow and spinal fluid showed no evident tumor cells. Transnasal biopsy revealed a chordoma. Treatment was initiated with a combination of ifosfamide, mesna, and etoposide along with radiation therapy to the cranial tumor. Shifting pulmonary densities were noted on serial films. Despite some clinical improvement, the child developed rapidly progressive hypoxemia 3 weeks after admission and died. Autopsy showed persistent viable tumor in the primary site and massive pulmonary arteriolar tumor emboli, infarcts, and widespread lung parenchymal metastases. No other sites of tumor involvement were discovered. This is the second child reported with intracranial chordoma, pulmonary metastases at diagnosis, and early death attributed to pulmonary tumor emboli.     

Potential biobehavioral mechanisms of recurrent abdominal pain in children

To explain why otherwise healthy children experience recurrent episodes of abdominal pain (the recurrent abdominal pain syndrome, or RAP), it has been hypothesized that the child with RAP demonstrates: (1) a deficit in autonomic nervous system recovery to stress, and/or (2) an enhanced behavioral and subjective response to pain. To evaluate the validity of these assumptions, children with RAP (9–14 years) and hospital and healthy controls matched for age, sex, ethnicity and SES were exposed to a cold pressor stimulus (0 ± 1°C). Autonomic (peripheral vasomotor and heart rate), somatic (forearm EMG), subjective (pain intensity and distress), and behavioral (facial expression) responses were recorded during baseline, stressor and recovery periods. At all 4 levels of observation, the cold pressor stimulus resulted in significant autonomic, somatic, subjective and behavioral arousal. However, no significant differential response across the 3 groups was noted for any measure and, in particular, no recovery deficit in autonomic arousal was demonstrated. These findings do not support the assumption of a differential response to an acute laboratory induced stress in children with RAP compared to control children.     

Familial covariation of the subclinical psychosis phenotype and verbal fluency in the general population

OBJECTIVE: Cognitive impairments may be markers of familial transmission of liability to psychosis. This study examined to what degree the subclinical psychosis phenotype in the general population shows similar familial continuity with cognition, measured with a verbal fluency test, and whether this was similar for men and women. METHODS: Measures of the subclinical psychosis phenotype and verbal fluency were administered to a general population sample of genetically related individuals (n=425). RESULTS: In men but not women, higher levels of the subclinical psychosis phenotype were associated with worse verbal fluency performance both within and across relatives. CONCLUSION: Psychosis and verbal fluency may be more strongly linked in men than in women, and this difference is also expressed at the subclinical level of the phenotype.     

Toxicity assessment of contaminated soils from an antitank firing range

Explosives are released into the environment at production and processing facilities, as well as through field use. These compounds may be toxic at relatively low concentrations to a number of ecological receptors. A toxicity assessment was carried out on soils from an explosive-contaminated site at a Canadian Forces Area Training Center. Toxicity studies on soil organisms using endpoints such as microbial processes (potential nitrification activity, dehydrogenase activity, substrate-induced respiration, basal respiration), plant seedling and growth (Lactuca sativa and Hordeum vulgare), and earthworm (Eisenia andrei) growth and reproduction were carried out. Results showed that 1,3,5,7-tetranitro-1,3,5,7-tetrazacyclooctane (HMX) was the principal polynitro-organic compound measured in soils. Soils from the contaminated site decreased microbial processes and earthworm reproduction; whereas plant growth was not significantly reduced. Toxicity to aquatic organisms and genotoxicity were also assessed on soil elutriates using Microtox (Vibrio fischeri), growth inhibition of algae (Selenastrum capricornutum), and SOS Chromotest (Escherichia coli). Results indicated that soil elutriates were generally not toxic to bacteria (Microtox) and algae. However, genotoxicity was found in a number of soil elutriate samples. Thus, the explosive-contaminated soils from the antitank firing range may represent a hazard for the soil organisms. Nevertheless, the global toxicity might have partially resulted from HMX as well as from other (not identified) contaminants such as heavy metals.     

Sleep disturbances, pain and analgesia in adults hospitalized for burn injuries

BACKGROUND AND PURPOSE: Sleep disturbances are frequently reported in hospitalized patients. We have recently shown significant daily relationships between poor sleep and acute burn pain during the first week of hospitalization, where poor sleep leads to reports of higher pain intensity and in return, greater pain affects quality of sleep. This prospective study was designed to objectively evaluate sleep disturbances in hospitalized burn patients and further evaluate their relationships with pain intensity and administered medication. PATIENTS AND METHODS: Sixteen non-ventilated burn patients wore an actigraph (Ambulatory Monitoring, Inc.) during hospitalization (N of 24-h observations 164). Sleep measures included duration and fragmentation (# of awakenings, mean duration of awakenings, mean duration of sleep episodes (MDAW)). Pain intensity was assessed at rest (nighttime, morning, during the day) and following therapeutic procedures known to be painful (e.g. dressing changes). RESULTS: Although sleep duration was extremely variable, patients slept an average of 5.5 h a night with numerous awakenings. During the day, patients often took naps, bringing their total sleep time (TST) to 8 h. Regression analyses showed significant temporal relationships between sleep, pain and analgesic medication such that a night of poor sleep was followed by a significantly more painful day and higher analgesic intake. Further, high levels of pain and analgesic medication during the day were both significant predictors of poor sleep on the following night. CONCLUSIONS: These results obtained with objective measures support previous findings that subjective sleep quality following burn injuries is poor, and strengthen the evidence of a relationship between sleep and sensitivity to pain. Nonetheless, further analyses are necessary to determine and dissociate the effects of pain intensity and analgesic medication on sleep.