Computed tomography (CT) is used liberally in the evaluation of pediatric trauma, even of low or moderate severity, because clinical examination of pediatric patients is considered unreliable. Appropriate utilization of valuable resources is essential in a cost-conscious medical era. The objective of this study is to determine if children with mild to moderate trauma are evaluated by more CT scans than adults with injuries of similar severity. Altogether, 108 pediatric patients less than 7 years old were matched according to mechanism of injury, Injury Severity Score (ISS), and the six individual body-region Abbreviated Injury Scores with adult patients admitted over the same 2-year period. All these patients had mild or moderate injuries (mean ISS 3.3 +/- 3.4). Pediatric patients had significantly more CT scans than adults, mostly because of a more liberal use of abdominal CT. CT scans of multiple body areas on the same patient were used more frequently in children but failed to identify more injuries compared to adults. None of the pediatric patients required an operation for abnormalities identified by CT. No differences were observed in morbidity, mortality, length of hospital stay, or length of intensive care unit stay for the two groups. It was concluded that a liberal policy of CT scanning for pediatric patients with a low ISS leads to increased resource consumption with no obvious diagnostic or treatment benefit.
PURPOSE: Dichlorotriazinyl aminofluorescein (DTAF) has been used to stain corneal stromal collagen as part of in vivo experimentation. Toxicity of this drug, if present, might alter the observed wound healing. To determine if this drug has any deleterious effect on keratocytes, we evaluated it in vitro. METHODS: Human keratocytes in 96 well plates were exposed to different concentrations of DTAF (10e-7, 10e-6, 10e-5, 10e-4, 10e-3, 10e-2, and 1Oe-I mg/ml of media). Exposure times of 1 and 24 hours at each concentration of DTAF were evaluated. The cell number was measured 1 and 3 days after exposure to the drug using a coulter-counter and a hemocytometer. RESULTS: The proliferation of keratocytes after 24 hours of exposure to the drug was inhibited in a dose dependent manner by DTAF, but 1 hour exposure of keratocytes to the drug did not inhibit keratocyte proliferation. CONCLUSION: These results suggest that DTAF has inhibitory effects on human keratocyte proliferation after 24 hours of exposure, while exposure limited to 1 hour does not induce such a change. [J Refract Surg 1997;13:568-570]
Dichlorotriazinyl aminofluorescein (DTAF) has been used to stain corneal stromal collagen as part of in vivo animal experiments for many years. Toxicity of this drug, if present, might alter the observed wound healing. To determine if this drug has any deleterious effect on keratocytes, we evaluated it in vitro. Human keratocytes prepared in 24-well plates were exposed to varying concentrations of DTAF (10(-4), 10(-3), 10(-2), 1, 10, 10(2) micrograms/ml). Exposure times of 1 hour and 24 hours at each concentration of DTAF were evaluated. The cell number was measured 1 and 3 days after initiation of exposure to DTAF using a Coulter counter. Keratocyte proliferation was not affected by 1-hour exposure to DTAF, but keratocyte proliferation measured 3 days after initiation of exposure to DTAF for 24 hours was inhibited in a dose-dependent manner (p = 0.02) and was significantly inhibited at concentrations of 10 and 100 micrograms/ml (p < 0.05). Fluorescent microscopy showed binding of DTAF to keratocytes. We have demonstrated that prolonged exposure to DTAF inhibits proliferation of cultured keratocytes. These results suggest that DTAF-induced cytotoxicity may alter net production of collagen in the corneal stroma in animal models.
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