Aggressive screening of patients with blunt head and neck trauma identified an incidence of BCVI in 1.03% of blunt admissions. Early identification, which led to early treatment, significantly reduced stroke rates in patients with VAI, but provided no outcome improvement with CAI. More encompassing screening may be required to improve outcomes for patients with CAI. However, less-invasive diagnostic techniques (CTA and MRA) are inadequate for screening. Technological advances are necessary before abandonment of conventional angiography, which remains the standard for diagnosis.

Extent of contusion volumes measured using three-dimensional reconstruction allows identification of patients at high risk of pulmonary dysfunction as characterized by development of ARDS. This method of measurement may provide a useful tool for the further study of PC as well as for the identification of patients at high risk of complications at whom future advances in therapy may be directed.

The management of stable patients with penetrating injuries to the neck that penetrate the platysma has evolved at our institution into selective surgical intervention based on clinical examination and CTA. The use of CTA has resulted in fewer formal neck explorations and virtual elimination of negative exploratory surgery.

Pregnant patients who sustain severe blunt trauma are infrequently encountered in most practices. However, detection of internal injuries including those to the gravid uterus is essential since maternal disability or fetal loss are physical and psychologic catastrophes that have long-term effects on the mother and her family. Computed tomography (CT) is commonly used to detect blunt traumatic injuries and can play an important role in the screening of the injured pregnant woman. The normal gravid uterus and physiologic changes of pregnancy can confound CT interpretation. Inhomogeneous enhancement of placental cotyledons, hydronephrosis, and enlarged ovarian veins are normal findings. Avascular regions in the placenta indicate infarction or abruption with impending fetal demise. Although CT can demonstrate uterine rupture and retroperitoneal hemorrhage, direct detection of fetal injuries is rare. Fetal demise is more common when maternal injuries include trauma to the uterus. Although screening ultrasonography can depict fetal distress, use of screening CT allows a concurrent evaluation of multiple areas in the pregnant trauma patient including the uterus. CT is a useful diagnostic tool in the triage of the critically injured pregnant woman.

The inhibition of highly biotinylated enzymes by avidin and streptavidin has been used in the development of homogeneous assays for biotin and other analytes. Usually, this inhibition occurs in a similar fashion for both avidin and streptavidin. Specifically, the curves that relate the inhibition of the enzymatic activity with the concentration of avidin or streptavidin have a sigmoidal shape; I.e., the inhibition of the enzyme-biotin conjugates increases gradually with increasing amounts of avidin or streptavidin and arrives at a plateau at high binding protein concentrations. However, when these two biotin-specific binding proteins interact with biotinylated glucose oxidase a significant difference in their inhibitory action is observed. In particular, the inhibition curves have a sigmoidal shape for streptavidin, while those for avidin exhibit a maximum ("hook") at low avidin concentrations. This difference in the reactivity of the two proteins with biotinylated enzymes influences both the shape of the dose-response curve and the detection limits of homogeneous enzyme-linked competitive binding assays for biotin.