Family physicians may be called upon to respond to trauma patients in their clinics or at scene of injury. Managing trauma can be daunting to any physician who encounters it infrequently. The physician first responder needs to shut out the chaos and distractions at scene and focus on a systematic primary survey to assess for injuries with the potential to cause rapid deterioration, institute crucial life-saving interventions and effect rapid evacuation to hospital. This article details a simple approach to guide the family physician to assess and prioritise management of the trauma patient, and augment the work of the paramedics in the pre-hospital phase.

Family physicians may be called upon to respond to trauma patients in their clinics or at scene of injury. Managing trauma can be daunting to any physician who encounters it infrequently. The physician first responder needs to shut out the chaos and distractions at scene and focus on a systematic primary survey to assess for injuries with the potential to cause rapid deterioration, institute crucial life-saving interventions and effect rapid evacuation to hospital. This article details a simple approach to guide the family physician to assess and prioritise management of the trauma patient, and augment the work of the paramedics in the pre-hospital phase.

Animals ; Catalysis ; Cell Adhesion ; drug effects ; radiation effects ; Humans ; Hydrophobic and Hydrophilic Interactions ; Osseointegration ; drug effects ; radiation effects ; Osteoblasts ; cytology ; drug effects ; radiation effects ; Osteogenesis ; drug effects ; radiation effects ; Photochemical Processes ; Surface Properties ; radiation effects ; Time Factors ; Titanium ; chemistry ; pharmacology ; radiation effects ; Ultraviolet Rays

Objective To investigate the clinical and pathological characteristics of urocpithelial sarcomatoid carcinoma of the urinary system,and improve the diagnosis and treatment of these tumors.Methods We reviewed the pathology comfirmed urinary system caicinoma at the General Hospital of PLA from January 1999 to December 2010 and analyzed the clinical and pathological data of cases with sarcomatoid carcinoma in them retrospectively according to the literatures. Results A total of 4386 urinary system carcinoma were comfirmed,among them 18 (0.41％) cases of sarcomatoid carcinoma were identified,including 13 from bladder,4 from ureter and 1 multiple neoplasm of pelvis and ureter.The patients,11 males and 7 female,had a median age of 63.3 years (41-84 yrs).Gross hematuria (18 cases) were the main presenting symptoms,3 with flank pain,4 with pollakisuria,urgency and dysuria (urinary irritation symptoms] and 5 with urinary obstruction.The patient with multiple neoplasm of pelvis and ureter received allograft renal transplantation 7 years ago and took anti-rejection drugs all the way after operation.17 patients underwent surgical resection,9 radical cystectomy,5 radical nephroureterectomy,3 partial cystectomy and the remain was biopsy.Tumor size ranged from 2.5 to 12 cm (median,5.6 cm).Microscopically,coexisting high grade urothelial carcinoma was present in all the 18 cases,12 with sarcomatoid differentiation,3 with sarcomatoid and squamous carcinoma differentiation and 3 with sarcomatoid and glandular differentiation.Sarcomatoid component occupied 10 -90 percent.Immunohistochemical testing showed the sarcomatoid cells were positive for cytokeratin (CK) and vimentin.12 patients died of disease 20 days to 42 months (median,5.3 months) postoperatively.3 patients have been surviving with tumor free for 3,3 and 17 months respectinely,and the other 3 was failure to be followed. Conclusions Sarcomatoid carcinoma of the urinary bladder is a highly malignant disease,and the prognosis is very poor.The diagnosis depends on histopathologic and immunohistochemical studies.Early diagnosis and cystectomy or nephroureterectomy together with chemotherapy/radiotherapy may improve the curative effect.

Objective:This study investigated the positive detection rate of cytoplasm thymidine kinase 1 (TK1) in lung cancer patients and the relationship of TK1 with clinicopathological features and prognosis. Methods:Sensitive chemiluminescence dot-blot assay was used to detect serum TK1 levels in 73 lung cancer patients and 56 normal control subjects. Results:The positive detection rate of TK1 was elevated in the lung cancer patients compared with the controls (P=0.006). The positive detection rate of TK1 was also correlated with distant metastases, but not with other factors, such as smoking, sex, lymph node metastasis, and pathology types. The 2 year survival of the patients with negative TK1 detection was significantly longer than that of the patients positively detected with the marker (P<0.001). Conclusion:Serum TK1, a new tumor marker, has potential applications in the diagnosis and prognosis of lung cancer.

BACKGROUND:Al ogeneic penetrating keratoplasty is the most effective method for treating corneal blindness. However, the incidence of rejections is high after keratoplasty, so it is urgent to develop an immunosuppressive drug with high efficacy and low toxicity. OBJECTIVE:To establish al ogeneic penetrating keratoplasty models and monitor the expression of tumor necrosis factor-αin blank control group and after transforming growth factor-β1 eyedrop during acute rejection period of corneal grafts. METHODS:Al ogeneic penetrating keratoplasty models were established and were randomly divided into blank control group, ciclosporin A group (1%ciclosporin A), and transforming growth factor-β1 group (1μg/ml transforming growth factor-β1 eyedrop). The medications from each group commenced at 1 day after surgery, one eyedrop once, three eyedrops per day. Al the operated eyes were given 0.3%ofloxacin ophthalmic solutions and 0.5%tropicaide ophthalmic solution, three times per day, for 12 days. The corneal grafts were harvested for hematoxylin-eosin staining and immunihistochemical staining (SABC method), to detect tumor necrosis factor-αexpression in corneal grafts. RESULTS AND CONCLUSION:Hematoxylin-eosin staining showed that, corneal grafts were significantly thickened, a large number of histoleucocytes and lymphocytes infiltrated in the blank control group;corneal grafts showed normal thickness and no inflammatory cel s infiltrated in the transforming growth factor-β1 group. Immunohistochemical staining showed that, there were less cel s positive for tumor necrosis factor-αin the transforming growth factor-β1 group compared with the blank control group (P<0.05). Transforming growth factor-β1 eyedrops can reduce the expression of tumor necrosis factor-αin the corneal grafts during acute rejection period, and reduce the inflammatory cel s infiltration in the corneal grafts, which is probably the mechanism of transforming growth factor-β1 to prevent and treat corneal al ograft rejection.

Objective To find out what kind of disease the uterine mass diagnosed by B-ultrasound is and discuss its outcome treated by hysteroscopy. Methods 78 cases of uterine mass were treated by hysteroscopy in our hospital from Auguest 2000 to July.2001, Masses were detected,cut out and sent for pathologic diagnosis. Results sixty-two cases (79.49%)(62/78)came to see their doctors with the symptoms,including abnormal bleeding (58) and abnormal discharge or abdominal pain(4).The other 16 cases were detected in regular physical examination without any complaint.No complication occurred during the operation.The results of pathology were as follows:endometrial polyp 51.3%(40/78),simplex hyperplasia 20.5%(16/78),complex hyperplasia 1.3%(1/78),atypical hyperplasia 2.6%(2/78),endometrial adenocarcinoma 1 3% (1/78),leiomyoma or adenomyoma 14.1%(11/78),incomplete abortion 1.3%(1/78),and no abnormolily 5 cases(6.4%).Thirty-five cases of mass were discovered in postmenopausal women and 85.7%(30/35)of cases were benign.Sixty-nine patients(88.5%)were followed up for (2～12)months after the operation.Sixty-five of them were satisfied with treatment.The satisfying rate was 94.2%.Especially with the postmenopausal women,all 31 cases were satisfied with the operation though 4 cases no longer contacted us. Conclusions Most of utering masses diagnosed by B ultrasound are benign.Hysteroscopy therapy is an appropriate method for the uterine mass in postmenopausal women.

Objective To investigate effect of coagulation, fibrinolysis, platelet and tumor markers in patients with advanced lung cancer by chemotherapy.Methods 21 cases of advanced lung cancer patients were selected to be the experiment group, and 20 healthy people were selected to be the control group.The experiment group were treated by chemotherapy,coagulation, fibrinolysis, platelet and tumor markers were compared before and after the treatment.ResuIts Compared with experiment group before chemotherapy, PT, APTT, TT levels of the patients after chemotherapy were lower, serum FIB concentrations were higher (P<0.05); PC and FPS were lower , D-D, PAI-1 concentration level were higher (P<0.05); PLT, MPV, PDW levels were lower (P<0.05); CEA, CYFRA21-1, NSE, CA125 levels were lower (P<0.05).ConcIusion Chemotherapy can enhance the effect of coagulation system in patients with advanced lung cancer, inhibit the fibrinolytic system and reduce the level of tumor markers.

Objective To measure von Willebrand factor(vWF)concentrations and von Willebrand factor-cleaving protease(vWF-cp)activity in plasma of lung cancer patients and to evaluate their clinical significance.Methods The vWF:antigen(vWF:Ag)and vWF-cp activity were measured by using ELISA and residual-collagen binding assay(R-CBA),respectively in 78 patients with lung cancer.The serum and pleural fluid(PLF)of carcino-embryonic antigen(CEA)were measured by radioimmunity assay in 23 patients.Results (1)The level of vWF:Ag in lung cancer patients(107.7?43.7)%was significantly higher than that in benign diseases(71.3?49.5)% and normal controls(82.4?41.3)%(P

[Objective]To investigate the cause precautionary measures and treatment countermeasure of impingement syndrome of the anterior ankle.[Method]From june 2000 to December 2004,18 cases of acute raumatic extravasated blood of the ankle without fracture and disbocating,20 cases of pain in front side and front inboard and front outside with dorsiflexion ache and dysfunction,all the cases were examined and treated under the arthroscope.The effect was analyzed.[Result]Follow-up lasted 6~52 months(mean 28 months).In all the 38 cases there were"excellent"outcomes in 17 cases"good"in 19 cases,"fair" in 0 case,and"poor" in 0 case in the acute traumatic extravasated blood of the ankle group.Impringement syndrome of the anterior ankle group:"excellent" in 15 cases"good" in 3 cases"fair"in 2 cases"poor"in 0 case.[Conclusion]Arthrotrauma and degranding are two reasons of the impingement syndrome of the anterior ankle,the initial stage arthroscope examination and treatment of the acute traumatic extravasated blood of the ankle without fracture and disbocating is the best active method to prevent the impingement syndrome of the anterior anlke,the clearing operation under the arthroscope is the best mininmally invasive treatment countermeasure for the impingement syndrome of the anterior ankle.