Rituximab appears to be a safe and effective therapeutic option in symptomatic patients with HCV-associated MC glomerulonephritis and signs of systemic vasculitis.

Conclusion:One third of patients with fatal blunt trauma have thoracic aortic injuries. The majority of deaths occur at the scene of the injury.Summary: There have been recent paradigm shifts in the management of blunt thoracic aortic trauma, including more widespread imaging using CT scanning, aggressive blood pressure control of patients who reach the hospital alive, delayed treatment of thoracic aortic injuries and more frequent use of endovascular techniques for repair of blunt thoracic trauma. These changes appear to have resulted in a decline in mortality from 22% to 13% for patients with thoracic aortic injuries who reach the hospital alive (Demetriades D. J Trauma 2008;64:1415-8). Many patients with blunt thoracic injury, however, cannot benefit from these advnces because they die at the scene of the accident. To develop some sense of the magnitude of this problem the authors analyzed autopsy findings in a series of blunt traumatic fatalities. They reviewed autopsies for blunt trauma performed by the Los Angeles County Coroner's Office in 2005. Victims without thoracic aortic trauma were compared with those with a traumatic thoracic aortic injury with respect to patterns of associated injuries and differences in baseline characteristics. During the study time there were 881 fatal victims of blunt trauma received by the Los Angeles County Department of Coroner. Of these 304 (35%) underwent a full autopsy and were included in the analysis here. Average age was 43 Ϯ 21 years and 71% were men. The most common mechanism of injury was a motor vehicle accident (50%) and the second most common was a pedestrians struck by an auto (37%). 102 of the 304 victims (34%) had a thoracic aortic injury. The descending thoracic aorta was the site of injury in 66%. Compared to patients without thoracic aortic injuries those with thoracic aortic injuries were more likely to have a cardiac injury (44% versus 25%; P ϭ .001), hemothorax (86% versus 56%; P Ͻ .001), rib fractures (86% versus 72%; P ϭ .006), and intra-abdominal injury (74% versus 49%; P Ͻ .001). Death at the scene was more likely if you had a thoracic aortic injury (80% versus 63%; P ϭ .002).Comment: It is not surprising most patients with thoracic aortic injury die at the accident scene. Motor vehicle accidents serve as the greatest source of thoracic aortic injury. It is interesting that despite advances in automotive and safety engineering the prevalence of blunt thoracic aortic injury in motor vehicle accidents does not seem to have been impacted by engineering advances. The association of thoracic aortic injury with motor vehicle accidents appears very similar to that, identified by Parmley, et. al. fifty years ago (Parmley LF. Circulation 1958;17:1086-101). However, it is possible engineering advances may have reduced the fatality rate of blunt aortic thoracic trauma following motor vehicle trauma without affecting its prevalence.

The aGAPSS is based upon a quantitative score and could aid risk stratifying APS patients younger than 50years for the likelihood of developing coronary thrombotic events and may guide pharmacological treatment for high-risk patients.

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