We investigated the relation between computed tomography measures of aortic calcification and values for bone density and the number of fragility fractures in 2348 healthy, postmenopausal women. To determine whether increases in vascular calcification and bone loss progress in parallel, baseline values were compared with measurements obtained 9 months to 8 yr later in a subgroup of 228 women. Of the 2348 subjects studied, 70% had osteoporosis, 30% had at least one vertebral fracture, and 9% had at least one hip fracture. Aortic calcifications were inversely related to bone density and directly related to fractures. After adjusting for age and potential confounders, measures for aortic calcification predicted 26.1% of the variance in bone density (P < 0.001). Compared with women without calcification, the odds ratios for vertebral and hip fractures in those with calcification were estimated to be 4.8 (95% confidence interval, 3.6-6.5) and 2.9 (95% confidence interval, 1.8-4.8), respectively. The subgroup analysis of 228 women longitudinally studied showed that the percentage of yearly increase in aortic calcification accounted for 47% of the variance in the percentage rate of bone loss (P < 0.001). Moreover, a strong graded association was observed between the progression of vascular calcification and bone loss for each quartile. Women in the highest quartile for gains in aortic calcification had four times greater yearly bone loss (5.3 vs.1.3% yearly; P < 0.001) than women of similar age in the lowest quartile. Smaller, but highly significant differences were also found between all other quartiles. We conclude that aortic calcifications are a strong predictor for low bone density and fragility fractures.

patients with signs of vascular injury had injury confirmed by angiography. Using angiography as the gold standard in the 59 patients, the overall sensitivity of physical examination to detect vascular injury in stable patients with gunshot wounds to the neck was 57%. Specificity was 53%, with positive and negative predictive values of 43% and 66%.Comment: In recent years, there has been a trend towards more conservative use of catheter-based angiography in patients with possible vascular injury. This trend has been most marked in the evaluation of patients with posterior knee dislocation and in the evaluation of stable patients with penetrating trauma to an extremity. The current data, however, suggest that hemodynamically stable patients with gunshot wounds to the neck should still undergo routine imaging evaluation. In some centers, this may be duplex scanning or computed tomography angiography rather than a catheter-based angiogram.

Together, these data indicate that sex is an important determinant of the morphology in humans well before the beginning of puberty.

INTRODUCTION:Pulmonary Embolism (PE) affects 0.5%-1 per 1000 people in the general population and the commonest cause of death among hospital inpatients. Intraoperative PE are relatively uncommon, but may occur with specific surgeries such as long bone fractures and tumor surgeries. Clinical presentation is usually sudden with cardiovascular collapse and death. In acute massive PE, 50% of the patient will die within 15 minutes and only 33 % will survive over 2 hours. CASE PRESENTATION:A 44-year-old Male patient presented with a right ankle fracture. He was scheduled for open reduction and internal fixation. Past medical history was negative. He smoked, drank alcohol and used cocaine. He is 110 kg, height of 190 cm. Patient underwent general anesthesia for the surgery. He was placed on mechanical ventilation to maintain end tidal carbon dioxide tension (ETCO2) between 30 to 35 mmHg. Vital signs remained stable until 60 minutes after induction, following positioning in the left lateral decubitus postion, it was noted that the ETCO2 was 17 mmHg. Pulse oximeter saturation (SPO2) ranging from 95 to 100%. Vital signs remained stable. An immediate search for the cause was undertaken. Auscultation of the chest showed vesicular breath sounds. The breathing circuit did not reveal any leaks or disconnects. Bronchoscopy also showed the endotracheal tube to be in proper position. A possible diagnosis of pulmonary embolism was made and an ABG was sent for analysis. ABG showed respiratory acidosis with a pH of 7.21, pCO2 of 76, with an ETCO2 of 17. The surgeon was notified and surgery was expedited. Patient was kept intubated. Spiral chest CT which showed a pulmonary embolus involving the right main pulmonary artery.The patient was transferred to the ICU where he was started on enoxaparin 1 mg per kg q 12 hours. He also had an IVC filter placed. He made a slow but gradually recovery and was discharged home 2 weeks later.