Communicating with the family: the risks of medical radiation to conceptuses in victims of major blunt-force torso trauma

Trauma in pregnancy: anatomical and physiological considerations

Management of a pregnant trauma victim is a relatively rare but stressful event, not least due to the need to consider two patients. Initial management by a trauma team should follow a structured approach applicable to all trauma patients, combined with knowledge of the specific problems encountered in pregnancy. This review outlines important anatomical and physiological changes that occur during pregnancy and their relevance to initial assessment and treatment. It discusses the epidemiology of trauma in pregnancy, the presentation and manage ment of specific problems and the methods of fetal assessment.

Awareness and attitudes amongst basic surgical trainees regarding radiation in orthopaedic trauma surgery

This study investigated the awareness and attitudes of basic surgical trainees. Trainees were asked to answer questions from a pre-set questionnaire. Fifty basic surgical trainees from England and Wales were involved in the study. The areas covered were basic knowledge of radiation hazards, use of protective wear, pregnancy test in female trauma victims of reproductive age, and principles of safe radiation. All the questions were asked in the context of orthopaedic trauma surgery. All questions were evidence based.It was unfortunate to notice that basic surgical trainees are lacking in the essential knowledge of ionising radiation. Most of the trainees are not adhering to radiation safety principle, and are not practising safely. The authors strongly recommend that surgical trainees should have more robust training and information available in this context. And they suggest that it should be provided on local, regional and national basis. © 2010 Biomedical Imaging and Intervention Journal. All rights reserved.

Pregnancy screening of adolescents and women before radiologic testing: does radiology need a national guideline?

Ionizing radiation has known teratogenic and cancer risks to fetuses. Policies for radiation exposure of pregnant patients during imaging tests in radiology departments vary widely and may or may not be in fully written form. No national guideline exists for how individual radiologists or radiology departments should protect fetuses from ionizing radiation exposure. With the rapid increase in the use of radiologic testing in general, particularly computed tomography, more adolescents and women undergo computed tomographic imaging and may unintentionally expose their fetuses. A national discussion within radiology organizations is needed to understand the advantages and disadvantages in the development of a national guideline for screening women of childbearing age for pregnancy before any procedures using ionizing radiation are performed. Given the increased public concern and increased use of radiologic testing, such a national guideline would improve consumer satisfaction and safety.

Proximal femoral focal deficiency as a manifestation of Antley-Bixler syndrome: a case report

We report a case of the Antley-Bixler syndrome in an 11-year-old girl. She presented with bilateral proximal femoral focal deficiency, right clubfoot, left radiohumeral synostosis, bilateral ear hypoplasia, cleft palate, tongue tie, missing teeth, congenital heart disease, a pelvic kidney with hydronephrosis, and mental retardation. Proximal femoral focal deficiency has never been reported before as a manifestation of Antley-Bixler syndrome. Her mother was exposed to radiation during an intravenous urogram done in the first trimester of pregnancy. Exposure to radiation has not been implicated as a cause of Antley-Bixler syndrome.

Trauma in pregnancy

OBJECTIVE

The objective of this article was to review the existing standards of practice regarding trauma which occurs during pregnancy.

DESIGN

The design of this study was to review the available data from the surgical and obstetrical literature regarding trauma during pregnancy. The design was also to incorporate the contemporary recommendations from the trauma resuscitation courses relating to trauma during pregnancy.

RESULTS

Trauma occurs in 5% of pregnancies. A fetus is not considered to be viable until week 25. Motor vehicle accidents account for more than 50% of all trauma during pregnancy, with 82% of fetal deaths occurring during these automobile accidents. With life threatening trauma a 50% fetal loss rate exists. As anatomy, physiology, and even laboratory findings change during pregnancy, the clinician must consider both patients, the mother and fetus. Following blunt trauma abruption of the placenta is the more common cause of fetus loss. Anterior abdominal penetrating trauma almost never fails to injury the uterus and fetus in the last half of pregnancy. Preventive strategies exist in the areas of social violence, automobile restraints and use of alcohol and drugs by the mother. Perimortem caesarian section is rarely successful.

CONCLUSIONS

Trauma during pregnancy is uncommon, but with increasing trauma severity leads to increased fetal loss. Preventive strategies exist and when admitted monitoring standards should be followed.

The effects of total-body irradiation on the survival and skin wound healing of rats with combined radiation-wound injury

To investigate the effects of total body irradiation on the healing of skin wounds, rats were irradiated with a (60)Co gamma-ray source, in which single doses ranged from 1 to 8 Gy. After irradiation, two whole-thickness circular skin wounds, 22 mm in diameter and covering 2.5% of the total body surface area, were made immediately on the back of each animal. The average healing time for the simple wound was 18.3 +/- 2.1 days, whereas when the wound was combined with 1, 2, 3, 4, 5, and 6 Gy of radiation, the average wound healing time was delayed by 0.3, 0.8, 1.1, 3.5, 6.2, and 9.5 days, respectively. The average healing time was significantly decreased with irradiation doses exceeding 4 Gy, as compared with the healing time for the simple wound without irradiation (p < 0.05). The statistical results showed that the percentage of the unclosed wound with the increased doses in combined radiation injury was significantly proportional to the recovery time kinetics.