No abstract

Applicability of Framingham risk equations for studying a low-income Mexican population.

Holstein calves were managed from less than 1 wk of age as in the special-fed veal industry but subjected to three dietary regimens (n = 10/group): low dietary iron (LI = approximately 5 mg iron/kg dry milk replacer) throughout 16 wk; 2) high then low dietary iron (H-LI = 140 mg/kg through d 18, then approximately 5 mg/kg through wk 16; a typical industrial scheme) or 3) high dietary iron (HI = approximately 105 mg/kg throughout the study). Several physiologic, behavioral and health indicators of welfare were monitored at various times. From wk 7 on, blood hemoglobin concentration was higher in HI calves than in LI, whereas that in H-LI calves was intermediate. Blood red cell count was higher in HI calves than in LI from wk 11 to 16, and was higher in HI than in H-LI from wk 14 to 16. Ratio of blood segmented neutrophils to lymphocytes (an indicator of stress) did not differ due to dietary regimen. Between wk 2 and 16, lying time increased from 69.5 to 76.6% of total time. Oral behaviors (e.g., licking and gnawing) occupied less than 15% of total time. Dietary regimen did not affect time spent either lying or engaging in oral behaviors. Calves in all dietary-regimen and slaughter-age groups experienced high frequencies of pneumonia, digestive-tract maladies and trichobezoars, but neither disease nor medical-treatment frequency was related to dietary regimen. Live, hot-dressed carcass and liver weights of the five calves/group slaughtered at 16 wk were not affected by dietary regimens, but carcass grade was highest for LI calves and lowest for HI.(ABSTRACT TRUNCATED AT 250 WORDS)

Background Controversy continues as to the most safe and reliable method for clearing the cervical spine (C-spine) in a trauma patient who is rendered unable to participate in a clinical examination. Although magnetic resonance imaging (MRI) is the most sensitive test to detect soft-tissue injuries, it is impractical for routine use in every patient largely because of its cost and time of acquiescence. Recent studies have advocated the sole use of multidetector computed tomographic (MDCT) scans of the C-spine to decide if cervical collar immobilization can be discontinued. The current investigation retrospectively reviewed a series of MDCT scans obtained after an acute traumatic event that were used to direct treatment in the emergency department (ED) or intensive care unit. Methods Seven-hundred and eight trauma patients consecutively admitted to the ED between June 2001 and July 2006 underwent a computed tomographic scan of their C-spine as part of an institutional protocol. We identified 91 patients with MDCT scans that were officially recorded as adequate and negative by an attending ED radiologist who had also undergone an MRI during the same trauma admission period. Retrospectively, two fellowship-trained spine surgeons independently reviewed these MDCT studies to address the following questions: (1) Is the study adequate? (2) Is it suggestive of an acute injury? (3) Is there sufficient information to safely recommend collar removal? Institutional Review Board approval was obtained before the images were reviewed. Neither clinical examination findings nor MRI readings were made available to the surgeon evaluators. Results Both spine surgeons agreed that 76 of the 91 studies (84%) were adequate to evaluate for possible C-spine injuries. Seven of 91 MDCT scans (8%) were deemed inadequate by both surgeons (95% confidence interval, 2.3–13.1). Reasons for inadequacy included motion artifact, insufficient visualization of the cervical-thoracic or occipital-cervical junctions, incomplete reconstructive views, or poor quality. Three of the adequate MDCT scans had fractures that were identified by both of the spine surgeons; 4 additional fractures and 15 findings suspicious for instability were identified by at least one of the surgeons. Ultimately, 22 of 91 MDCT scans read as adequate and normal by attending radiologists were deemed suspicious for abnormality by the spine surgeons. Of these 22 cases, the official MRI reading was positive for a trauma-related abnormality in 17 cases. Conclusions C-spine clearance of patients without the ability participate in a clinical examination remains difficult. A multidisciplinary, algorithmic approach generally yields the most consistent results. However, our data highlight that reliance on a single imaging modality may lead to missed diagnosis of C-spine injuries. These data suggest that early involvement of the spine service for radiographic clearance may help identify occult injuries or suspicious findings necessitating further evaluation.