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For your convenience, find the Trauma List Archive Below

trauma-list Digest, Vol 56, Issue 15

stephengrant at comcast.net stephengrant at comcast.net
Thu Feb 14 14:57:45 GMT 2008 

please remove this e-mail address from the list server.

--
J. Stephen Grant, MS, RN, CEN, EMT-P 
Voice - (904) 866-8098 
Fax - (904) 268-5271

-------------- Original message -------------- 
From: trauma-list-request at trauma.org 

> Send trauma-list mailing list submissions to 
> trauma-list at trauma.org 
> 
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> http://list.mistral.net/mailman/listinfo/trauma-list 
> or, via email, send a message with subject or body 'help' to 
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> 
> When replying, please edit your Subject line so it is more specific 
> than "Re: Contents of trauma-list digest..." 
> 
> 
> Today's Topics: 
> 
> 1. RE: Who's doing 1:1 blood transfusions for shock? 
> (William Bromberg) 
> 2. Re: Who's doing 1:1 blood transfusions for shock? AND WHY 
> (KMATTOX at aol.com) 
> 3. 1:1 blood transfusions for shock (Christos Giannou) 
> 4. RE: CT confirmation of healing spleen (tina) 
> 5. Re: CT confirmation of healing spleen (SJASMD at aol.com) 
> 6. Re: CT confirmation of healing spleen (SJASMD at aol.com) 
> 7. Re: CT confirmation of healing spleen (SJASMD at aol.com) 
> 8. Re: (no subject) (SJASMD at aol.com) 
> 9. Re: CT confirmation of healing spleen (SJASMD at aol.com) 
> 10. RE: CT confirmation of healing spleen (tina) 
> 11. RE: CT confirmation of healing spleen (Ronald Gross) 
> 12. Re: CT confirmation of healing spleen (Ronald Gross) 
> 13. Re: CT confirmation of healing spleen (Ronald Gross) 
> 
> 
> ---------------------------------------------------------------------- 
> 
> Message: 1 
> Date: Wed, 13 Feb 2008 08:28:49 -0500 
> From: "William Bromberg" 
> Subject: RE: Who's doing 1:1 blood transfusions for shock? 
> To: "'Trauma & Critical Care mailing list'" 
> 
> Message-ID: <47B2AA41.85AB.003A.0 at memorialhealth.com> 
> Content-Type: text/plain; charset=US-ASCII 
> 
> Also, have you all seen the new whitepaper from the transfusion medicine people 
> about TRALI and the use of female plasma? It looks like the plasma supply just 
> got cut in half more or less. The link is from the lay press (but not a bad 
> article). 
> 
> http://www.sptimes.com/2007/01/23/Worldandnation/Lung_injury_tied_to_f.shtml 
> 
> Bill 
> 
> >>> "Karim Brohi" 2/12/2008 6:41 PM >>> 
> << It has NOT been universally accepted, however, and I am not sure why. >> 
> Ron 
> 
> Because one swallow doesn't make a spring, and one retrospective military 
> study shouldn't change global practice. 
> 
> 
> 
> There are significant implications for providing 1:1 plasma instead of 1:3 - 
> more use of AB plasma, increased risks, increased work for transfusion 
> staff, increased likelihood of error, and inability to keep up (Par 
> Johansson, a world-class transfusionist in Copenhagen has been running 1:1 
> for years and has modelled resource provision. He is clear that provision 
> of 1:1 ratios during multiple casualty events is almost impossible). 
> 
> Now I'm not saying that 1:1 is not the right thing to do. It may be, but 
> we have a suggestion of effect and that is all at present. Read the 
> Cochrane review on plasma therapy - for any indication. There's so little 
> evidence out there it behoves us to investigate this more thoroughly before 
> we expose our patients to 3-4 times the dose of a product we have little 
> knowledge of. 
> 
> Sadly I'm speaking 'For' 1:1 in Vegas - which is much easier and more boring 
> :-) 
> 
> Karim 
> 
> -- 
> trauma-list : TRAUMA.ORG 
> To change your settings or unsubscribe visit: 
> http://www.trauma.org/index.php?/community/ 
> 
> 
> 
> 
> ------------------------------ 
> 
> Message: 2 
> Date: Wed, 13 Feb 2008 08:36:43 EST 
> From: KMATTOX at aol.com 
> Subject: Re: Who's doing 1:1 blood transfusions for shock? AND WHY 
> To: trauma-list at trauma.org 
> Message-ID: 
> Content-Type: text/plain; charset="US-ASCII" 
> 
> I know the course director - ME 
> I know the moderator of THE DEBATE - Mike Sise 
> I know the debaters - Karim and Dr. Wisner from Sacramento 
> I have seen their scripts. 
> YES, I agree. It will be a great session, and I don't really know who will 
> will win. It will all be in the delivery. You MUST not miss this debate 
> and the other 50 presentations of this conference. 
> I do know that even two weeks before the close of EARLY registration we are 
> already discussing when we might close the registration as being over 
> subscribed. We we summarizing and projecting closure dates just yesterday. 
> SOOOOOOOOOO 
> 
> 
> In a message dated 2/13/2008 1:59:27 A.M. Central Standard Time, 
> karim at trauma.org writes: 
> 
> Totally agree - it'll be a great session. _www.trauma-criticalcare.com_ 
> (http://www.trauma-criticalcare.com/) 
> And I'm going to win. 
> K 
> 
> -----Original Message----- 
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] 
> On Behalf Of Ronald Gross 
> Sent: 13 February 2008 00:59 
> To: trauma-list at trauma.org 
> Subject: RE: Who's doing 1:1 blood transfusions for shock? 
> 
> "Sadly I'm speaking 'For' 1:1 in Vegas - which is much easier and more 
> boring" 
> 
> 
> 
> 
> **************The year's hottest artists on the red carpet at the Grammy 
> Awards. Go to AOL Music. 
> (http://music.aol.com/grammys?NCID=aolcmp00300000002565) 
> 
> 
> ------------------------------ 
> 
> Message: 3 
> Date: Wed, 13 Feb 2008 17:41:39 +0200 
> From: "Christos Giannou" 
> Subject: 1:1 blood transfusions for shock 
> To: trauma-list at trauma.org 
> Message-ID: 
> <64c08ba00802130741n16a301b7g74401542d69bc800 at mail.gmail.com> 
> Content-Type: text/plain; charset=ISO-8859-1 
> 
> I understand your concerns Karim, especially concerning one retrospective 
> military study, but a small note of caution when one speaks of "global 
> practice". 
> 
> Many hospitals in the world (the majority?) do not have access to blood 
> components. For many of us, the standard is whole blood, as fresh as 
> possible, and usually donated by a family member. I understand that what is 
> under discussion is practice in the industrialised world -- and certain 
> capital cities of the Third World -- but would also mention that recent 
> "military studies" from Iraq and Afghanistan have also extolled the benefits 
> of fresh whole blood for shock. 
> 
> One idea might be to start swinging the pendulum back a bit. I imagine there 
> is a whole cohort of senior, not to say elderly, surgeons on the list who 
> started their practice using whole blood, in glass bottles! (Wonderful piece 
> of equipment to have around for autotransfusion.) Perhaps some basic 
> research in an antiquated pre-blood-component technique would be in order. 
> Our colleagues in the industrialised world would have to help us out, 
> however. Not a simple task to do much research in a bush hospital, although 
> the US military is trying with their forward surgical teams. 
> 
> best regards, 
> 
> -- 
> chris giannou 
> senior surgeon 
> international committee of the red cross 
> Monemvasia Lakonia 
> 23070 Greece 
> 
> 
> ------------------------------ 
> 
> Message: 4 
> Date: Wed, 13 Feb 2008 22:31:18 +0100 
> From: "tina" 
> Subject: RE: CT confirmation of healing spleen 
> To: "'Trauma & Critical Care mailing list'" 
> 
> Message-ID: <000101c86e87$c568a8f0$5039fad0$@no> 
> Content-Type: text/plain; charset="us-ascii" 
> 
> Agree with Tim...comments so far seem to sum up nicely what we know about 
> follow-up after splenic injuries...very little. Even with a CT like this, 
> most would let him go back to unrestricted activity if he is otherwise 
> fine...so is there a place for late follow-up CT scans in clinically 
> restituted patients? Also I don't know of any evidence for restricting 
> activity 6 months? 
> 
> We stopped doing late follow-up CT scans for splenic injuries a few years 
> ago..as we often ended up worrying about the CT appearance, however still 
> letting the patient go back to unrestricted activity after 8-12 weeks if 
> feeling ok, 12 weeks for grade 4/5, no evidence.. 
> 
> Tina Gaarder 
> Oslo 
> 
> -----Original Message----- 
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] 
> On Behalf Of Hardcastle, Tim, Dr 
> Sent: 13. februar 2008 06:01 
> To: Trauma & Critical Care mailing list 
> Subject: RE: CT confirmation of healing spleen 
> 
> Allen 
> 
> Since folow-up CT does not predict failure, I'm not sure about whether it 
> should have been done, but since he is well and likely to have a new capsule 
> - sure, why not! 
> 
> Tim 
> 
> -----Original Message----- 
> From: trauma-list-bounces at trauma.org 
> [mailto:trauma-list-bounces at trauma.org]On Behalf Of 
> gsuywy at pacific.net.sg 
> Sent: Tuesday, February 12, 2008 6:31 PM 
> To: Trauma & Critical Care mailing list 
> Subject: CT confirmation of healing spleen 
> 
> 
> Dear all 
> I would appreciate the opinion of the members on the CT confirmation 
> of a healed ruptured spleen. The CT scan is of a 20 year old male 
> injured in a MVC - initial CT showing a splenic injury managed 
> conservatively and another 6 months later showing a ? fibrous band 
> joining the 2 fragments. 
> 
> Is this sufficient evidence to allow him to go back to contact sports? 
> Or is the band expected to narrow even further in the future? 
> 
> Thanks very much 
> 
> Allen 
> -- 
> trauma-list : TRAUMA.ORG 
> To change your settings or unsubscribe visit: 
> http://www.trauma.org/index.php?/community/ 
> 
> 
> 
> 
> ------------------------------ 
> 
> Message: 5 
> Date: Thu, 14 Feb 2008 01:24:59 EST 
> From: SJASMD at aol.com 
> Subject: Re: CT confirmation of healing spleen 
> To: trauma-list at trauma.org 
> Message-ID: 
> Content-Type: text/plain; charset="US-ASCII" 
> 
> 
> In a message dated 2/12/2008 5:32:44 P.M. W. Europe Standard Time, 
> gsuywy at pacific.net.sg writes: 
> 
> Dear all 
> I would appreciate the opinion of the members on the CT confirmation 
> of a healed ruptured spleen. The CT scan is of a 20 year old male 
> injured in a MVC - initial CT showing a splenic injury managed 
> conservatively and another 6 months later showing a ? fibrous band 
> joining the 2 fragments. 
> 
> Is this sufficient evidence to allow him to go back to contact sports? 
> Or is the band expected to narrow even further in the future? 
> 
> Thanks very much 
> 
> Allen 
> 
> 
> 
> no it is not evidence predictive of anything. 
> 
> Looks healed though. I would manage as if this were healed even if there 
> were no scan 
> 
> sal 
> 
> 
> 
> **************The year's hottest artists on the red carpet at the Grammy 
> Awards. Go to AOL Music. 
> (http://music.aol.com/grammys?NCID=aolcmp00300000002565) 
> 
> 
> ------------------------------ 
> 
> Message: 6 
> Date: Thu, 14 Feb 2008 01:25:52 EST 
> From: SJASMD at aol.com 
> Subject: Re: CT confirmation of healing spleen 
> To: trauma-list at trauma.org 
> Message-ID: 
> Content-Type: text/plain; charset="US-ASCII" 
> 
> 
> In a message dated 2/12/2008 6:03:55 P.M. W. Europe Standard Time, 
> Rgross at harthosp.org writes: 
> 
> Allen, 
> 
> Even in the absence of a blush on this cut, I am amazed that you got away 
> with this!! Now, having said that, I would personally let the kid go back to 
> contact sports. 
> 
> Ron 
> 
> 
> 
> ron 
> 
> ive treated far worse conservatively with uneventful outcomes 
> 
> sal 
> 
> 
> 
> **************The year's hottest artists on the red carpet at the Grammy 
> Awards. Go to AOL Music. 
> (http://music.aol.com/grammys?NCID=aolcmp00300000002565) 
> 
> 
> ------------------------------ 
> 
> Message: 7 
> Date: Thu, 14 Feb 2008 01:30:07 EST 
> From: SJASMD at aol.com 
> Subject: Re: CT confirmation of healing spleen 
> To: trauma-list at trauma.org 
> Message-ID: 
> Content-Type: text/plain; charset="US-ASCII" 
> 
> 
> In a message dated 2/12/2008 8:17:32 P.M. W. Europe Standard Time, 
> Rgross at harthosp.org writes: 
> 
> Hey Sal, are you out there? Have you seen this kind of defect on a healed 
> spleen? 
> 
> >>> "Ronald Simon" 2/12/2008 12:31 PM >>> 
> Yea, i know....... BUT, as you said, that was quite the crack to begin with. 
> Personally, i have never seen such a large remaining defect. That said, i 
> learn and see new stuff everyday. 
> ron 
> 
> 
> just catching up. 
> 
> we have seen patients who ended up healing two separate splenic segments do 
> very well, and our patients have some interesting "contact" sports to contend 
> with 
> 
> however i must remind that we do empiric angiography and will embolize 
> anyone with a angiographic blush. So our experience is kind of different. 
> 
> sal 
> 
> 
> 
> **************The year's hottest artists on the red carpet at the Grammy 
> Awards. Go to AOL Music. 
> (http://music.aol.com/grammys?NCID=aolcmp00300000002565) 
> 
> 
> ------------------------------ 
> 
> Message: 8 
> Date: Thu, 14 Feb 2008 01:38:08 EST 
> From: SJASMD at aol.com 
> Subject: Re: (no subject) 
> To: trauma-list at trauma.org 
> Message-ID: 
> Content-Type: text/plain; charset="US-ASCII" 
> 
> 
> i might have mentioned this a long time ago but let me share this 
> utilization review nightmare with you all. 
> 
> when we started doing nonop management in 1978 based upon angiographic 
> findings, we kept all patients in the hospital until the injuries healed 
> substantially on 
> CT scans done TWO WEEKS apart. Longest hospitalization was about twelve 
> weeks, most healed within 2-6 weeks. About 30% of patients underwent 
> embolization. 
> 
> in those days in a municipal hospital, no one questioned it at all. 
> 
> Never had any rebleeds. 
> 
> Sounds ridiculous but that seemed reasonable back then as an alternative to 
> splenectomy. 
> 
> Thankfully reason has set in and we send our patients home in 3-5 days., 
> Don't reangio, don't CT, don't waste so much money 
> 
> sal 
> 
> In a message dated 2/12/2008 7:18:38 P.M. W. Europe Standard Time, 
> djinmori at terra.com.br writes: 
> 
> Hi Allen 
> 
> We have been followed our non-operative management of splenic and/or hepatic 
> trauma patients since 1993. Early 
> phase we have "taken care" these patients closer and we have let them out of 
> their activities. Nowadays we 
> allow then to return to their lives after 4 to 6 weeks just after we check a 
> new image study (sometimes US or 
> CT-scan) 
> 
> The next question would be: how sure we would be about splenic function? 
> Probably a novell of opinions 
> 
> And finally, if we are not able to confirm the splenic function, is it 
> necessary to prevent of post-splenectomy 
> sepsis? 
> 
> Nice case. 
> 
> 
> Surgical Emergency Service 
> Hospital das Clinicas - Sao Paulo - Brazil 
> MD Newton Djin Mori 
> djinmori at terra.com.br 
> 
> 
> 
> 
> 
> 
> 
> **************The year's hottest artists on the red carpet at the Grammy 
> Awards. Go to AOL Music. 
> (http://music.aol.com/grammys?NCID=aolcmp00300000002565) 
> 
> 
> ------------------------------ 
> 
> Message: 9 
> Date: Thu, 14 Feb 2008 01:41:42 EST 
> From: SJASMD at aol.com 
> Subject: Re: CT confirmation of healing spleen 
> To: trauma-list at trauma.org 
> Message-ID: 
> Content-Type: text/plain; charset="US-ASCII" 
> 
> 
> In a message dated 2/13/2008 10:32:01 P.M. W. Europe Standard Time, 
> tinagaar at online.no writes: 
> 
> Agree with Tim...comments so far seem to sum up nicely what we know about 
> follow-up after splenic injuries...very little. Even with a CT like this, 
> most would let him go back to unrestricted activity if he is otherwise 
> fine...so is there a place for late follow-up CT scans in clinically 
> restituted patients? 
> 
> 
> 1.development of esophageal varices 
> 2. bruit 
> 3. persistent pain 
> 4. persistent anemia 
> 5. 
> 
> sal 
> 
> 
> 
> **************The year's hottest artists on the red carpet at the Grammy 
> Awards. Go to AOL Music. 
> (http://music.aol.com/grammys?NCID=aolcmp00300000002565) 
> 
> 
> ------------------------------ 
> 
> Message: 10 
> Date: Thu, 14 Feb 2008 08:01:02 +0100 
> From: "tina" 
> Subject: RE: CT confirmation of healing spleen 
> To: "'Trauma & Critical Care mailing list'" 
> 
> Message-ID: <000601c86ed7$5cbaa920$162ffb60$@no> 
> Content-Type: text/plain; charset="US-ASCII" 
> 
> Fully agree and thank you for the clarification...:-) however, those would 
> in my mind mostly be the non-restituted ones, ie the patients presenting at 
> follow-up with some kind of symptoms or reduced function (except for the 
> bruit) and thus qualify for CT scan. 
> 
> Tina 
> -----Original Message----- 
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] 
> On Behalf Of SJASMD at aol.com 
> Sent: 14. februar 2008 07:42 
> To: trauma-list at trauma.org 
> Subject: Re: CT confirmation of healing spleen 
> 
> 
> In a message dated 2/13/2008 10:32:01 P.M. W. Europe Standard Time, 
> tinagaar at online.no writes: 
> 
> Agree with Tim...comments so far seem to sum up nicely what we know about 
> follow-up after splenic injuries...very little. Even with a CT like this, 
> most would let him go back to unrestricted activity if he is otherwise 
> fine...so is there a place for late follow-up CT scans in clinically 
> restituted patients? 
> 
> 
> 1.development of esophageal varices 
> 2. bruit 
> 3. persistent pain 
> 4. persistent anemia 
> 5. 
> 
> sal 
> 
> 
> 
> **************The year's hottest artists on the red carpet at the Grammy 
> Awards. Go to AOL Music. 
> (http://music.aol.com/grammys?NCID=aolcmp00300000002565) 
> -- 
> trauma-list : TRAUMA.ORG 
> To change your settings or unsubscribe visit: 
> http://www.trauma.org/index.php?/community/ 
> 
> 
> 
> 
> ------------------------------ 
> 
> Message: 11 
> Date: Thu, 14 Feb 2008 06:44:56 -0500 
> From: "Ronald Gross" 
> Subject: RE: CT confirmation of healing spleen 
> To: "'Trauma & Critical Care mailing list'" 
> 
> Message-ID: <47B3E368.7FF1.00B9.0 at harthosp.org> 
> Content-Type: text/plain; charset=US-ASCII 
> 
> Tina, 
> 
> I am there with you. In my practice, if we were lucky enough to have gotten 
> away with non-op therapy, a spleen looking like the original one projected would 
> remain in an athlete who would be out of the game till the next season, without 
> a f/u CT scan. 
> 
> Ron 
> >>> "tina" 2/13/2008 4:31 PM >>> 
> Agree with Tim...comments so far seem to sum up nicely what we know about 
> follow-up after splenic injuries...very little. Even with a CT like this, 
> most would let him go back to unrestricted activity if he is otherwise 
> fine...so is there a place for late follow-up CT scans in clinically 
> restituted patients? Also I don't know of any evidence for restricting 
> activity 6 months? 
> 
> We stopped doing late follow-up CT scans for splenic injuries a few years 
> ago..as we often ended up worrying about the CT appearance, however still 
> letting the patient go back to unrestricted activity after 8-12 weeks if 
> feeling ok, 12 weeks for grade 4/5, no evidence.. 
> 
> Tina Gaarder 
> Oslo 
> 
> -----Original Message----- 
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] 
> On Behalf Of Hardcastle, Tim, Dr 
> Sent: 13. februar 2008 06:01 
> To: Trauma & Critical Care mailing list 
> Subject: RE: CT confirmation of healing spleen 
> 
> Allen 
> 
> Since folow-up CT does not predict failure, I'm not sure about whether it 
> should have been done, but since he is well and likely to have a new capsule 
> - sure, why not! 
> 
> Tim 
> 
> -----Original Message----- 
> From: trauma-list-bounces at trauma.org 
> [mailto:trauma-list-bounces at trauma.org]On Behalf Of 
> gsuywy at pacific.net.sg 
> Sent: Tuesday, February 12, 2008 6:31 PM 
> To: Trauma & Critical Care mailing list 
> Subject: CT confirmation of healing spleen 
> 
> 
> Dear all 
> I would appreciate the opinion of the members on the CT confirmation 
> of a healed ruptured spleen. The CT scan is of a 20 year old male 
> injured in a MVC - initial CT showing a splenic injury managed 
> conservatively and another 6 months later showing a ? fibrous band 
> joining the 2 fragments. 
> 
> Is this sufficient evidence to allow him to go back to contact sports? 
> Or is the band expected to narrow even further in the future? 
> 
> Thanks very much 
> 
> Allen 
> -- 
> trauma-list : TRAUMA.ORG 
> To change your settings or unsubscribe visit: 
> http://www.trauma.org/index.php?/community/ 
> 
> 
> -- 
> trauma-list : TRAUMA.ORG 
> To change your settings or unsubscribe visit: 
> http://www.trauma.org/index.php?/community/ 
> 
> 
> 
> ------------------------------ 
> 
> Message: 12 
> Date: Thu, 14 Feb 2008 06:51:34 -0500 
> From: "Ronald Gross" 
> Subject: Re: CT confirmation of healing spleen 
> To: 
> Message-ID: <47B3E4F6.7FF1.00B9.0 at harthosp.org> 
> Content-Type: text/plain; charset=US-ASCII 
> 
> Sal, 
> 
> I am pretty sure we all have - but not without significant "sphincter 
> tightening"! ;-) 
> 
> Best wishes, 
> Ron 
> 
> 
> 
> >>> 2/14/2008 1:25 AM >>> 
> 
> In a message dated 2/12/2008 6:03:55 P.M. W. Europe Standard Time, 
> Rgross at harthosp.org writes: 
> 
> Allen, 
> 
> Even in the absence of a blush on this cut, I am amazed that you got away 
> with this!! Now, having said that, I would personally let the kid go back to 
> contact sports. 
> 
> Ron 
> 
> 
> 
> ron 
> 
> ive treated far worse conservatively with uneventful outcomes 
> 
> sal 
> 
> 
> 
> **************The year's hottest artists on the red carpet at the Grammy 
> Awards. Go to AOL Music. 
> (http://music.aol.com/grammys?NCID=aolcmp00300000002565) 
> -- 
> trauma-list : TRAUMA.ORG 
> To change your settings or unsubscribe visit: 
> http://www.trauma.org/index.php?/community/ 
> 
> 
> 
> ------------------------------ 
> 
> Message: 13 
> Date: Thu, 14 Feb 2008 06:53:19 -0500 
> From: "Ronald Gross" 
> Subject: Re: CT confirmation of healing spleen 
> To: 
> Message-ID: <47B3E55F.7FF1.00B9.0 at harthosp.org> 
> Content-Type: text/plain; charset=US-ASCII 
> 
> Sal, 
> This image has no blush - but I wonder about the rest of the scan. Based ONLY 
> on this image, would you have squirted this kid? 
> Ron 
> 
> >>> 2/14/2008 1:30 AM >>> 
> 
> In a message dated 2/12/2008 8:17:32 P.M. W. Europe Standard Time, 
> Rgross at harthosp.org writes: 
> 
> Hey Sal, are you out there? Have you seen this kind of defect on a healed 
> spleen? 
> 
> >>> "Ronald Simon" 2/12/2008 12:31 PM >>> 
> Yea, i know....... BUT, as you said, that was quite the crack to begin with. 
> Personally, i have never seen such a large remaining defect. That said, i 
> learn and see new stuff everyday. 
> ron 
> 
> 
> just catching up. 
> 
> we have seen patients who ended up healing two separate splenic segments do 
> very well, and our patients have some interesting "contact" sports to contend 
> with 
> 
> however i must remind that we do empiric angiography and will embolize 
> anyone with a angiographic blush. So our experience is kind of different. 
> 
> sal 
> 
> 
> 
> **************The year's hottest artists on the red carpet at the Grammy 
> Awards. Go to AOL Music. 
> (http://music.aol.com/grammys?NCID=aolcmp00300000002565) 
> -- 
> trauma-list : TRAUMA.ORG 
> To change your settings or unsubscribe visit: 
> http://www.trauma.org/index.php?/community/ 
> 
> 
> 
> ------------------------------ 
> 
> -- 
> trauma-list : TRAUMA.ORG 
> To change your settings or unsubscribe visit: 
> http://www.trauma.org/index.php?/community/ 
> 
> End of trauma-list Digest, Vol 56, Issue 15 
> *******************************************

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