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Any buzz in the field on NovoSeven for trauma
Timothy Craig Hardcastle TimothyHar at ialch.co.zaWed May 14 07:36:06 BST 2008
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Michael My previous institution was (and I presume, is) involved in the phase 111 trial. My only comment based on what you say below here is that the exclusion criteria made it possible to really include only about 1 in 10 -14 screened patients. My personal feeling is that the criteria were too selective. But, that was then! 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 Michael Novod Sent: 13 May 2008 17:56 To: trauma-list at trauma.org Subject: Re: Any buzz in the field on NovoSeven for trauma Importance: High Hi Bill, What I know is, is that an interim analysis i scheduled for August and that htese patients are in a quite severe condition. Hence what I'm speculating is how difficult it will be to generate good enough data in order to support further phase III studies an a potential registration in trauma. No doubt that N7 works in real life, it has just been so difficult to prove in clinical settings and for these severe cases it would be fantastic to get something approved that could be game changing. I have also heard a lot of pros and cons about this particular study, but I guess the largest problem is the condition of the patients when finally administered N7. The producer knows from the agency that if they cannot show the clinical effect in this interim analysis, the study will be shot down and data reported in clinical journals. Michael 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 This e-mail may be confidential. If you have received this e-mail in error please note that you may not copy or use the contents or attachments in any way, and in that case please destroy this entire message and notify the sender. E-mails are not secure and Svenska Handelsbanken AB (publ) cannot accept responsibility if they are intercepted, diverted or corrupted or contain viruses. trauma-list-request at trauma.org Sent by: trauma-list-bounces at trauma.org 13/05/2008 17:26 Please respond to trauma-list at trauma.org To trauma-list at trauma.org cc Subject trauma-list Digest, Vol 59, Issue 19 Send trauma-list mailing list submissions to trauma-list at trauma.org To subscribe or unsubscribe via the World Wide Web, visit http://list.mistral.net/mailman/listinfo/trauma-list or, via email, send a message with subject or body 'help' to trauma-list-request at trauma.org You can reach the person managing the list at trauma-list-owner at trauma.org When replying, please edit your Subject line so it is more specific than "Re: Contents of trauma-list digest..." Today's Topics: 1. Any buzz in the field on NovoSeven for trauma (Michael Novod) 2. Help unsubscribe (Birch, Keith P (GE Infra, Water)) 3. Re: Any buzz in the field on NovoSeven for trauma (William Bromberg) 4. Re: Any buzz in the field on NovoSeven for trauma (KMATTOX at aol.com) 5. head injury and aspirin (daniel simon) ----- Message from Michael Novod <mino03 at handelsbanken.se> on Tue, 13 May 2008 13:04:53 +0200 ----- To: trauma-list at trauma.org Subject: Any buzz in the field on NovoSeven for trauma 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 This e-mail may be confidential. If you have received this e-mail in error please note that you may not copy or use the contents or attachments in any way, and in that case please destroy this entire message and notify the sender. E-mails are not secure and Svenska Handelsbanken AB (publ) cannot accept responsibility if they are intercepted, diverted or corrupted or contain viruses. trauma-list-request at trauma.org Sent by: trauma-list-bounces at trauma.org 06/05/2008 13:01 Please respond to trauma-list at trauma.org To trauma-list at trauma.org cc Subject trauma-list Digest, Vol 59, Issue 9 Send trauma-list mailing list submissions to trauma-list at trauma.org To subscribe or unsubscribe via the World Wide Web, visit http://list.mistral.net/mailman/listinfo/trauma-list or, via email, send a message with subject or body 'help' to trauma-list-request at trauma.org You can reach the person managing the list at trauma-list-owner at trauma.org When replying, please edit your Subject line so it is more specific than "Re: Contents of trauma-list digest..." 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 & 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 & 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 **************Wondering what's for Dinner Tonight? Get new twists on family favorites at AOL Food. (http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001) -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ __________ NOD32 3073 (20080505) Information __________ This message was checked by NOD32 antivirus system. http://www.eset.com -- 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/ __________ NOD32 3076 (20080505) Information __________ This message was checked by NOD32 antivirus system. http://www.eset.com ----- Message from "Timothy Craig Hardcastle" <TimothyHar at ialch.co.za> on Tue, 6 May 2008 08:03:47 +0200 ----- To: "Trauma & 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. **************Wondering what's for Dinner Tonight? Get new twists on family favorites at AOL Food. (http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001) -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ ----- 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 -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ ----- Message from "Birch, Keith P (GE Infra, Water)" <Keith.Birch at ge.com> on Tue, 13 May 2008 13:51:03 +0100 ----- To: <trauma-list at trauma.org> Subject: Help unsubscribe Please can you unsubscribe me from the list. Best Regards Keith Birch ----- Message from "William Bromberg" <brombwi1 at memorialhealth.com> on Tue, 13 May 2008 11:00:18 -0400 ----- To: <trauma-list at trauma.org> Subject: Re: Any buzz in the field on NovoSeven for trauma 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 This e-mail may be confidential. If you have received this e-mail in error please note that you may not copy or use the contents or attachments in any way, and in that case please destroy this entire message and notify the sender. E-mails are not secure and Svenska Handelsbanken AB (publ) cannot accept responsibility if they are intercepted, diverted or corrupted or contain viruses. trauma-list-request at trauma.org Sent by: trauma-list-bounces at trauma.org 06/05/2008 13:01 Please respond to trauma-list at trauma.org To trauma-list at trauma.org cc Subject trauma-list Digest, Vol 59, Issue 9 Send trauma-list mailing list submissions to trauma-list at trauma.org To subscribe or unsubscribe via the World Wide Web, visit http://list.mistral.net/mailman/listinfo/trauma-list or, via email, send a message with subject or body 'help' to trauma-list-request at trauma.org You can reach the person managing the list at trauma-list-owner at trauma.org When replying, please edit your Subject line so it is more specific than "Re: Contents of trauma-list digest..." 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 & 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 & 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 **************Wondering what's for Dinner Tonight? Get new twists on family favorites at AOL Food. (http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001) -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ __________ NOD32 3073 (20080505) Information __________ This message was checked by NOD32 antivirus system. http://www.eset.com -- 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/ __________ NOD32 3076 (20080505) Information __________ This message was checked by NOD32 antivirus system. http://www.eset.com ----- Message from "Timothy Craig Hardcastle" <TimothyHar at ialch.co.za> on Tue, 6 May 2008 08:03:47 +0200 ----- To: "Trauma & 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. **************Wondering what's for Dinner Tonight? Get new twists on family favorites at AOL Food. (http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001) -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ ----- 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 -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ ----- Message from KMATTOX at aol.com on Tue, 13 May 2008 11:13:21 EDT ----- To: trauma-list at trauma.org Subject: Re: Any buzz in the field on NovoSeven for trauma 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 This e-mail may be confidential. If you have received this e-mail in error please note that you may not copy or use the contents or attachments in any way, and in that case please destroy this entire message and notify the sender. E-mails are not secure and Svenska Handelsbanken AB (publ) cannot accept responsibility if they are intercepted, diverted or corrupted or contain viruses. trauma-list-request at trauma.org Sent by: trauma-list-bounces at trauma.org 06/05/2008 13:01 Please respond to trauma-list at trauma.org To trauma-list at trauma.org cc Subject trauma-list Digest, Vol 59, Issue 9 Send trauma-list mailing list submissions to trauma-list at trauma.org To subscribe or unsubscribe via the World Wide Web, visit http://list.mistral.net/mailman/listinfo/trauma-list or, via email, send a message with subject or body 'help' to trauma-list-request at trauma.org You can reach the person managing the list at trauma-list-owner at trauma.org When replying, please edit your Subject line so it is more specific than "Re: Contents of trauma-list digest..." 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 & 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 & 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 **************Wondering what's for Dinner Tonight? Get new twists on family favorites at AOL Food. (http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001) -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ __________ NOD32 3073 (20080505) Information __________ This message was checked by NOD32 antivirus system. http://www.eset.com -- 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/ __________ NOD32 3076 (20080505) Information __________ This message was checked by NOD32 antivirus system. http://www.eset.com ----- Message from "Timothy Craig Hardcastle" <TimothyHar at ialch.co.za> on Tue, 6 May 2008 08:03:47 +0200 ----- To: "Trauma & 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. **************Wondering what's for Dinner Tonight? Get new twists on family favorites at AOL Food. (http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001) -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/ ----- 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 -- 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/ **************Wondering what's for Dinner Tonight? Get new twists on family favorites at AOL Food. (http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001) ----- Message from "daniel simon" <danielsimonster at gmail.com> on Tue, 13 May 2008 18:24:11 +0300 ----- To: trauma-list at trauma.org Subject: head injury and aspirin An elderly ( 82YO) pedestrian was hit by a car. His GCS is 11, his injuries include cerebral contusions, small SDH, multiple rib fractures and a femur fracture. He is intubated and ventilated.He is on aspirin. The neurosurgeon wants to give him 6 units of platelets, The ED physician vocally argues against it.. What is your opinion? [attachment "ry1.JPG" deleted by Michael Novod/MINO03/SHB] -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/index.php?/community/
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