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Tue May 13 16:13:21 BST 2008

I have no NEW insider information.   I watch carefully for any  new 
publications with comparisons.   Like everyone I have the AAST  multicenter study, put 
together by the S. African group.    I  continue to hear testimonials both pro 
and con.    I even once a  month search the internet for anything NEW that I 
might have  missed.        

k

In a message dated 5/13/2008 10:02:37 A.M. Central Daylight Time,  
brombwi1 at memorialhealth.com writes:

I'll  give you my insider info if you give me yours. 

>>> Michael  Novod <mino03 at handelsbanken.se> 5/13/2008 7:04 AM >>>
Anyone  who has any heard any buzz in the field for NovoSeven in trauma, 
for which  phase III trials are currently being conducted and for which an 
interim  analysis are pending? All info or recent experience with NovoSeven 
in  trauma is highly appreciated.

Michael Novod, Sector Head,  Pharmaceuticals & Biotech
Senior Analyst, Equity & Credit  Research

Havneholmen 29
DK-1561 Copenhagen V, Denmark
phone: +45  3341 8618, mobile: +45 2972 0161
fax: +45 3341 8552
e-mail:  mino03 at handelsbanken.dk 
http://www.handelsbanken.com/capitalmarkets  

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Today's Topics:

1. RE:  interesting zone I GSW (Dr. Haim Paran)
2. RE: interesting  zone I GSW (Timothy Craig Hardcastle)
3. OT to Tim Coats  (Mathias Kalkum)

----- Message from "Dr. Haim Paran"  <paran620 at green.co.il> on Tue, 06 May 
2008 06:38:23 +0300  -----
To:
"'Trauma &amp; Critical Care mailing list'"  <trauma-list at trauma.org>
Subject:
RE: interesting zone I GSW
No  evidence yet, but CTA in this case could show the tract, unseen  
hematomas
missed by the angio and also the damage to other structures.  If the CTA
would show a suspected vessel damage, then depending of the kind  of injury
either go directly to surgery or, as Dr. Mattox probably would  want, 
confirm
with angio.

Haim Paran

-----Original  Message-----
From: trauma-list-bounces at trauma.org  
[mailto:trauma-list-bounces at trauma.org] 
On Behalf Of sjasmd at aol.com  
Sent: Tuesday, May 06, 2008 3:29 AM
To: trauma-list at trauma.org  
Subject: Re: interesting zone I GSW

haim
sorry,let me try  again

what is the evidence concerning accuracy of CTA compared to the  gold
standard catheter based angiography for penetrating trauma of the  great
vessels?

sal

-----Original  Message-----
From: Dr. Haim Paran <paran620 at green.co.il>
To:  'Trauma &amp; Critical Care mailing list'  <trauma-list at trauma.org>
Sent: Mon, 5 May 2008 1:40 pm
Subject:  RE: interesting zone I GSW

I think I would have started with a  CT-angio in the first place.

Haim Paran

-----Original  Message-----
From: trauma-list-bounces at trauma.org  
[mailto:trauma-list-bounces at trauma.org] 
On Behalf Of SJASMD at aol.com  
Sent: Monday, May 05, 2008 3:05 PM
To: trauma-list at trauma.org  
Subject: Re: interesting zone I GSW

In a message dated 5/4/2008  11:27:57 P.M. Eastern Standard Time, 
shebrain1 at yahoo.com writes:

I  would  do very careful exam to R/O any other GSW to abd, to help explain  

his  hypotension which i think is due to hemorrhage and possible  initial 
neurogenic  origin.

how about his LU pulse exam,  any  difference? any bruit over 
supraclavicular

region , any  arm swelling, that  might suggest AVF with Hyperdynamic state  

that can explain his increased  BP.

the Chest Tube out put  is 1600 ml Over how long  time? or better how  much 

over the  last 2-3 hours?

if patient remained stable with decreasing CT out put,  I would  obesrve, 
if 
any Q about integrity of aorta I would have  IVUS to  evlaute.
I would admit to ICU, get EKG and possible TEE  and  observe.unless become 
unstable.

ss

no  other injuries
pulses symetrical
no bruit
no arm swelling
possibly  over resuscitated to cause bp increase?
output was over about six hours. by  end of angio, output stopped. still 
residual blood in the chest
ekg  normal
currently being observed

would ken mattox do a CT of the  chest after a negative  angiogram?

sal

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----- Message from "Timothy Craig Hardcastle"  <TimothyHar at ialch.co.za> on 
Tue, 6 May 2008 08:03:47 +0200  -----
To:
"Trauma &amp; Critical Care mailing list"  <trauma-list at trauma.org>
Subject:
RE: interesting zone I  GSW
Sal

At least my suggestion was reasonable - the CT, I mean. I  suspect Ken
was right about the contrast concentration. I would always do  this under
bypass in a controlled fashion in a patient who has stabilized.  This is
likely to be a case of mobilize and oversew rather than a resection  and
graft, but I stand to be corrected.

Tim
Dr Timothy C  Hardcastle
M.B., Ch.B. (Stell); M. Med (Chir) (Stell); FCS  (SA)
Principal Surgeon-Lecturer / Sub-specialist: Trauma and Critical  Care
Deputy director: Trauma Unit and Trauma ICU
Inkosi Albert Luthuli  Central Hospital / UKZN
800 Bellair Road
Mayville, Durban

Postal:  PostNet Suite 27
Private Bag X05
Malvern, 4055
KwaZulu  Natal

timothyhar at ialch.co.za 

-----Original  Message-----
From: trauma-list-bounces at trauma.org  
[mailto:trauma-list-bounces at trauma.org] On Behalf Of sjasmd at aol.com  
Sent: 06 May 2008 04:14
To: trauma-list at trauma.org 
Subject: Re:  interesting zone I GSW

ken I, like you, have not jumped on the CTA  bandwagon for vascular
trauma, although in the long run I think it will  replace catheter based
angiography. i just havent found the data  convincing. lots of anecodatal
reports, lots of focused prejudicial patient  selection, etc. This case
did however show the value of CTA. 

after  the aortogram,? esophagogram and venogram,?the cause of the
bleeding had  not been identifed. Since he appeared to have stopped
bleeding and remained  stable, he was brought to CT to evaluate his
thoracic spine injury.  Contrary to the plan, the chief resident asked
for the spine CT with  contrast media and that turned into a CTA.

The CTA showed that there  was a large residual hematoma in the
mediastinum and through and through  penetrations of the aorta. The
anterior hole was situated about five  millimeters directly below the
origin of the left commoon carotid artery.  The bullet traversed inside
the lumen of the aorta to exit the posterior  wall of the top of the
descending aorta.(see attached)

I was struck  by the quality of the images and by the beautiful way the
relationships  were illustrated. The cardiothoracic surgeon said that his
comprehension of  the injury was enhanced and that led to a more
assertive surgical  plan.

I am surprised that the aortogram was normal and the CT was  positive. It
is a very rare event that such injuries do not manifest better  than
this. I suspect that thrombus contained the injries and that  the
resuscitation increased his blood pressure and that led to popping  the
clot.

to my surgical colleagues, i am curious about how they  would approach
this injury. pump? bypass? clamp and sew? simple  suturing?

sal

-----Original Message-----
From:  KMATTOX at aol.com 
To: trauma-list at trauma.org 
Sent: Mon, 5 May 2008 8:41  pm
Subject: Re: interesting zone I GSW

I have been BURNED so  many times by a CTA that I have totally lost faith
in 
them.   I see the same problem at many other institutions  where  the
present 
cases to me when I am a visiting professor.   CTA for Chest vascular
injury 
is a VOMIT.  

k

In a message dated 5/5/2008 12:41:17 P.M. Central  Daylight Time, 
paran620 at green.co.il writes:

I think  I would  have started with a CT-angio in the first   place.

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-----  Message from Mathias Kalkum <listen at doc-kalkum.de> on Tue, 06 May  
2008 10:29:50 +0200 -----
To:
Trauma Org  <trauma-list at trauma.org>
Subject:
OT to Tim Coats
Dear  Tim,

I have just received the CRASH2 newsletter (12th issue). That  picture - 
are you standing on the left or the right?

Just  curious.

Kind regards!

Mathias

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