Significant Correlation of Trauma Epidemiology With the Economic Conditions of a Community
Hypothesis: Depressed economic conditions are associated with increased trauma and violent crime.
Design: Retrospective cohort study of prospectively collected data.
Setting and Interventions: Population and labor force data from 1992 to 2002 were obtained from the state Employment Development Department and the US Census Bureau. County data regarding the total number of trauma activations and mechanism of trauma were recorded. Crime statistics were obtained from the state Department of Justice and the Federal Bureau of Investigation. Correlation statistics were performed. Health care coverage for victims of penetrating trauma was also analyzed.
Main Outcome Measures: Correlation between unemployment rate, trauma epidemiology, and crime indexes.
Results: The correlation between the percentage penetrating trauma and the unemployment rate was R = 0.92 (Orange County, California) and R = 0.95 (Los Angeles County, California) (P<.001). The unemployment rate was also tightly correlated with Federal Bureau of Investigation crime indexes in both counties and in the state (P<.001). The overall county population was positively correlated with the total number of trauma occurrences in both counties (P<.001) but was negatively correlated with the number of penetrating traumas and crime indexes (P<.001). Seventy-five percent of penetrating trauma victims had no health care coverage or had state or county aid only.
Conclusions: The proportion of violent crime in a community is closely associated with the unemployment rate of that community and will vary longitudinally over time. The overall county population is less important. These data may be used for public policy initiatives regarding resource allocation to trauma centers, law enforcement planning, and programs aimed at crime prevention.
Cinat ME, Wilson SE, Lush S, Atkins C
Treatment of Diffuse Basal Cell Carcinomas and Basaloid Follicular Hamartomas in Nevoid Basal Cell Carcinoma Syndrome by Wide-Area 5-Aminolevulinic Acid Photodynamic Therapy
Objective: To report the use of wide-area 5-aminolevulinic acid photodynamic therapy to treat numerous basal cell carcinomas (BCCs) and basaloid follicular hamartomas (BFHs).
Design: Report of cases.
Setting: Roswell Park Cancer Institute. Patients Three children with BCCs and BFHs involving 12% to 25% of their body surface areas. Interventions Twenty percent 5-aminolevulinic acid was applied to up to 22% of the body surface for 24 hours under occlusion. A dye laser and a lamp illuminated fields up to 7 cm and 16 cm in diameter, respectively; up to 36 fields were treated per session.
Main Outcome Measures: Morbidity, patient response, and light dose-photodynamic therapy response relationship and durability.
Results: Morbidity was minimal, with selective phototoxicity and rapid healing. After 4 to 7 sessions, with individual areas receiving 1 to 3 treatments, the patients had 85% to 98% overall clearance and excellent cosmetic outcomes without scarring. For laser treatments, a sigmoidal light dose-response relationship predicted more than 85% initial response rates for light doses 150 J/cm(2) or more. Responses were durable up to 6 years.
Conclusion: 5-Aminolevulinic acid photodynamic therapy is safe, well tolerated, and effective for extensive areas of diffuse BCCs and BFHs and appears to be the treatment of choice in children.
Oseroff AR, Shieh S, Frawley NP, et al.
Health- and Vision-Related Quality of Life Among Patients With Ocular Histoplasmosis or Idiopathic Choroidal Neovascularization at Enrollment in a Randomized Trial of Submacular Surgery: Submacular Surgery Trials Report No. 5.
Objectives: To (1) summarize vision-targeted and general health-related quality-of-life scores at baseline and quantify the effect of the ophthalmic problem, (2) evaluate the strength of relations between visual acuity and interview scores, and (3) compare scores for patients who also had choroidal neovascular lesions in the fellow eye (bilateral cases) with those of patients who had choroidal neovascularization in only the study eye (unilateral cases) at time of enrollment in a randomized trial of surgical removal of subfoveal choroidal neovascularization, either associated with the ocular histoplasmosis syndrome or of idiopathic origin.
Design: Eligible patients had subfoveal choroidal neovascularization (including some classic choroidal neovascularization) and a visual acuity of 20/50 to 20/800 (Snellen equivalent), inclusive, in the eye to be assigned randomly to surgery or observation. Interviews that incorporated the 39-item version of the National Eye Institute Visual Function Questionnaire (NEI-VFQ) and 2 other instruments were conducted by telephone by trained interviewers before patients enrolled and were assigned randomly to surgery or observation. Information from baseline clinical examinations and fluorescein angiograms interpreted centrally by masked readers was used to classify patients as unilateral or bilateral cases and to provide potential explanations for variability of interview responses using linear regression models.
Results: The median overall NEI-VFQ score was 75 (interquartile range, 60-84). The median scores on individual subscales ranged from 55 (general vision) to 100 (color vision). The visual acuity of the better-seeing eye accounted for much of the variability in scores on most NEI-VFQ subscales; a 3-line difference in visual acuity was associated with a 10-point or greater difference in scores on 5 subscales after adjustment for other characteristics of patients and eyes. Scores on most scales of all 3 instruments differed between unilateral cases (n = 167) and bilateral cases (n = 58). Even after adjustment for visual acuity and reading speed of the better-seeing eye, age, gender, and scores on the other instruments, scores on the NEI-VFQ near and distance activities subscales differed by almost 13 and 10 points, respectively, between unilateral and bilateral cases. Neither age nor gender was an important independent explanatory variable for NEI-VFQ scores.
Conclusions: Unilateral and bilateral cases had vision-targeted health-related quality-of-life scores worse than those published for a reference population without eye disease. Furthermore, despite younger age, better visual acuity, and better short-term visual prognosis, bilateral cases had NEI-VFQ scores at baseline similar to those published for 2 groups of patients with age-related macular degeneration. Unidentified factors, in addition to the visual acuity of the better-seeing eye, affected patients' perceptions of visual function.
Submacular Surgery Trials Research Group
Midfacial Reconstruction Using Calvarial Split Bone Grafts
Objective: To evaluate the success rate of free calvarial grafts for midfacial reconstruction, the relevance of soft tissue coverage, and the influence of radiotherapy.
Design: Retrospective analysis.
Setting: University medical center.
Patients: Fifty-six patients (27 tumor cases, 24 trauma cases, and 5 others) underwent bony midface reconstruction using calvarial grafts in the past 11 years. Half of the patients with tumor were additionally treated with radiation.
Interventions: A total of 95 bone transplants were used for reconstruction of the zygoma, orbit, and nasal bone. Graft survival and complications were evaluated. Grafts with total and partial soft tissue coverage were compared. The influence of radiotherapy in the tumor patient group was determined.
Results: Graft survival was 95.8%. One nasal dorsum graft was totally resorbed. Infection occurred in 9 cases, leading to only 1 total and 2 partial graft losses. The incidence of dysfunction of the eye due to globe malposition after reconstruction of the orbital walls was low. A correlation between radiation and transplant loss as well as between soft tissue coverage and graft survival could not be found.
Conclusions: For midfacial reconstruction, it is not necessary to fully cover calvarial bone grafts by the surrounding soft tissue. Even in patients who will undergo postoperative irradiation, calvarial bone grafts are a reliable alternative in selected cases.
Smolka W, Eggensperger N, Kollar A, Iizuka T
Abstracts: In Other AMA Journals. Arch Facial Plast Surg. 2005;7(3):207-208. doi: