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Objective Complementary and alternative medicine (CAM) seems to be frequently used among patients with inflammatory bowel disease (IBD). We aimed to determine the prevalence and indicators of CAM use in Austrian IBD patients. Methods In a multicentre cross-sectional study, adult patients with IBD attending 18 Austrian outpatient clinics completed a multi-item questionnaire that recorded use of CAM as well as medical and socioeconomic characteristics. Patients were recruited between June 2014 and June 2015. The study outcome was the prevalence of CAM use and its socioeconomic and disease-related associations. Results A total of 1286 patients (Crohn's disease 830, ulcerative colitis 435, IBD unclassified 21; females 651) with a median age of 40 years (interquartile range 31-52 years) and a median disease duration of 10 years (4-18 years) were analysed. The prevalence of previous and/or current CAM use was 50.7%, with similar results for Crohn's disease and ulcerative colitis. In the multivariable analysis, female gender and a university education were independent socioeconomic indicators of CAM use. IBD-related indicators were longer duration of the disease and previous and/or current treatment with steroids and TNF-α inhibitors. Conclusion CAM use for IBD is frequent in Austrian IBD patients and associated with female gender, higher educational level of university degree, longer duration of the disease, and treatment with steroids and TNF-α inhibitors.

Acetabular exposure for direct anterior (DA) total hip arthroplasty (THA) can be performed using hands-free, self-retaining retractors. No current study quantitatively compares this self-retaining technique with the traditional manual technique. In 65 consecutive DA THA hips, two “best-view” digital photographs were taken of the exposure—one using Charnley/self-retaining retractors and one using a traditional three-retractor manual technique. Percent exposure of the polyethylene liner was calculated. Percent acetabular exposure averaged 80.0% using the Charnley/self-retaining technique, compared with 73.1% using the manual technique ( P =.0002). A hands-free technique provides superior acetabular exposure compared with the manual technique. Increasing body mass index predicts decreasing exposure with both techniques. [ Orthopedics . 2021;44(2):e309–e313.]

Introduction Patients with inflammatory bowel disease (IBD) suffer from various symptoms, impairing their quality of life and often affecting psychosocial issues. This may lead to the need for additional psychological care. This study investigated patients' subjective need for integrated psychosomatic support and psychotherapy and indicators for it. Materials and methods This is a cross‐sectional multicentre study in Austrian IBD patients who were in routine care at 18 IBD outpatient clinics. Patients filled in an anonymous, validated questionnaire (Assessment of the Demand for Additional Psychological Treatment Questionnaire [ADAPT]) assessing the need for psychological care. The ADAPT gives two separate scores: the need for integrated psychosomatic support and for psychotherapy. In addition, health‐related quality of life and the use of complementary and alternative medicine as well as clinical and socio‐demographic variables were queried. Multivariable regression analysis was performed to estimate the effect of the previously mentioned variables on the need for additional psychological care. Results Of 1286 patients, 29.7% expressed a need for additional psychological care, 19.6% expressed a need for integrated psychosomatic support and 20.2% expressed a need for psychotherapy. In the multivariable analysis, the two strongest indicators for the need for both types of psychological care were the use of complementary and alternative medicine (for integrated psychosomatic support: odds ratio = 1.64, 95% confidence interval 1.13–2.39, p = 0.010; for psychotherapy: odds ratio = 1.74, 95% confidence interval 1.20–2.53, p = 0.004), and a low health‐related quality of life score (for integrated psychosomatic support: odds ratio = 0.95, 95% confidence interval 0.94–0.96, p, Key summary What is already known? Despite ongoing improvement of treatment options, patients may not respond to treatment or may develop side effects. Due to this burden of disease, patients may also suffer from psychological symptoms, such as depressionIn our previous study in 2008, we found that 31% of patients with inflammatory bowel disease (IBD) expressed a subjective need for psychological interventions What are the significant and/or new findings of the study? Despite improvements in therapy, around 30% of patients with IBD express a subjective need for psychological interventionsThis subjective need for psychological interventions is associated with complementary and alternative medicine use and low quality of life

Background The association between fine particulate matter and cardiovascular disease has been convincingly demonstrated. The role of traffic‐related air pollutants is less clear. To better understand the role of traffic‐related air pollutants in cardiovascular disease development, we examined associations between NO 2 , carotid atherosclerotic plaque, and cardiometabolic disorders associated with cardiovascular disease. Methods and Results Cross‐sectional analyses were conducted among 2227 patients (62.9±13.8 years; 49.5% women) from the Stroke Prevention and Atherosclerosis Research Centre (SPARC) in London, Ontario, Canada. Total carotid plaque area measured by ultrasound, cardiometabolic disorders, and residential locations were provided by SPARC medical records. Long‐term outdoor residential NO 2 concentrations were generated by a land use regression model. Associations between NO 2 , total carotid plaque area, and cardiometabolic disorders were examined using multiple regression models adjusted for age, sex, smoking, and socioeconomic status. Mean NO 2 was 5.4±1.6 ppb in London, Ontario. NO 2 was associated with a significant increase in plaque (3.4 mm 2 total carotid plaque area per 1 ppb NO 2 ), exhibiting a linear dose‐response. NO 2 was also positively associated with triglycerides, total cholesterol, and the ratio of low‐ to high‐density lipoprotein cholesterol ( P 2 and total carotid plaque area ( P Conclusions Our results demonstrate that even low levels of traffic‐related air pollutants are linked to atherosclerotic plaque burden, an association that may be partially attributable to pollution‐induced diabetes mellitus. Our findings suggest that reducing ambient concentrations in cities with NO 2 below current standards would result in additional health benefits. Given the billions of people exposed to traffic emissions, our study supports the global public health significance of reducing air pollution.

This study examined three meat-restricted diets (N = 865)-a vegetarian diet, a reduced-meat diet, and a chicken-free diet-with a focus on the differences in lived dietary experiences operationalized using measures such as satisfaction with food-related life and the theory of planned behavior. The data comes from an online survey of a census-balanced sample of 30,000+ U.S. residents. The findings showed that meat reducers are a larger group than suspected and that there was a statistically significant difference in dietary experiences with vegetarians reporting better experiences with their diet. This research speaks to how the type of meat restriction impacts lived experiences.

Background Firefighters, police, and armed services may be exposed to hazards such as combustion by-products and shift work. Methods The CanCHEC cohort linked 1991 census data to the Canadian cancer registry for follow up. Cox proportional hazards modeling was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) to estimate risks for firefighter, police, or armed forces compared to workers in other occupations. Results The cohort of 1 108 410 men included 4535 firefighters, 10 055 police, and 9165 armed forces. For firefighters, elevated risks were noted for Hodgkin's lymphoma (HR: 2.89, 95%CI: 1.29-6.46), melanoma (HR: 1.67, 95%CI: 1.17-2.37), and prostate cancer (HR: 1.18, 95%CI: 1.01-1.37). Police had elevated risks for melanoma (HR:1.69, 95%CI: 1.32-2.16) and prostate cancer (HR:1.28, 95%CI: 1.14-1.42). No significant associations were found for armed forces workers. Conclusions Canadian firefighters, police, and armed services, may be at an increased risk of developing certain cancers. Results suggested that a healthy worker effect may influence risk estimates.

As there are no well‐established modifiable risk factors for prostate cancer, further evidence is needed on possible factors such as occupation. Our study uses one of the largest Canadian worker cohorts to examine occupation, industry, and prostate cancer and to assess patterns of prostate cancer rates. The Canadian Census Health and Environment Cohort (CanCHEC) was established by linking the 1991 Canadian Census Cohort to the Canadian Cancer Database (1969–2010), Canadian Mortality Database (1991–2011), and Tax Summary Files (1981–2011). A total of 37,695 prostate cancer cases were identified in men aged 25–74 based on age at diagnosis. Cox proportional hazards models were used to estimate hazards ratios and 95% confidence intervals. In men aged 25–74 years, elevated risks were observed in the following occupations: senior management (HR = 1.12, 95% CI: 1.04–1.20); office and administration (HR = 1.19, 95% CI: 1.11–1.27); finance services (HR = 1.09, 95% CI: 1.04–1.14); education (HR = 1.05, 95% CI: 1.00–1.11); agriculture and farm management (HR = 1.12, 95% CI: 1.06–1.17); farm work (HR = 1.11, 95% CI: 1.01–1.21); construction managers (HR = 1.07, 95% CI: 1.01–1.14); firefighting (HR = 1.17, 95% CI: 1.01–1.36); and police work (HR = 1.22, 95% CI: 1.09–1.36). Decreased risks were observed across other construction and transportation occupations. Results by industry were consistent with occupation results. Associations were identified for white‐collar, agriculture, protective services, construction, and transportation occupations. These findings emphasize the need for further study of job‐related exposures and the potential influence of nonoccupational factors such as screening practices.

Objectives Shift work with circadian disruption is a suspected human carcinogen. Additional population-representative human studies are needed and large population-based linkage cohorts have been explored as an option for surveillance shift work and cancer risk. This study uses a surveillance linkage cohort and job-exposure matrix to test relationships. Methods We estimated associations between shift work and breast, ovarian, and prostate cancer using the population-based Canadian Census Health and Environment Cohort (CanCHEC), linking the 1991 Canadian census to national cancer registry and mortality databases. Prevalence estimates from population labour survey data were used to estimate and assign probability of night, rotating, or evening shifts by occupation and industry. Cohort members were assigned to high (>50%), medium (>25 to 50%), low (>5 to 25%), or no ( Results The cohort included 1 098 935 men and 939 520 women. Hazard ratios (HRs) indicated null or inverse relationships comparing high probability to no exposure for prostate cancer: HR = 0.96, 95% confidence interval (CI) = 0.91–1.02; breast cancer: HR = 0.94, 95% CI = 0.90–0.99; and ovarian cancer: HR = 0.99, 95% CI = 0.87–1.13. Conclusions This study showed inverse and null associations between shift work exposure and incidence of prostate, breast, or ovarian cancer. However, we explore limitations of a surveillance cohort, including a possible healthy worker survivor effect and the possibility that this relationship may require the nuanced exposure detail in primary collection studies to be measurable.

Delayed diagnosis seems to be common in inflammatory bowel diseases (IBD). The study was carried out to investigate the diagnostic delay and associated risk factors in Austrian IBD patients. In a multicenter cross-sectional study adult patients with IBD attending 18 Austrian outpatient clinics completed a multi-item questionnaire that recorded medical and socioeconomic characteristics. The study outcome was diagnostic delay defined as the period from symptom onset to diagnosis of IBD. A total of 1286 patients (Crohn’s disease 830, ulcerative colitis 435, inflammatory bowel disease unclassified 21; females 651) with a median age of 40 years (interquartile range 31–52 years) and a median disease duration of 10 years (4–18 years) were analyzed. The median diagnostic delay was 6 months (2–23 months) in Crohn’s disease and 3 months (1–10 months) in ulcerative colitis (p

The independent and joint effects of within- and between-city contrasts in air pollution on mortality have been investigated rarely. To examine the differential effects of between- versus within-city contrasts in pollution exposure, we used both ambient measurements and land use regression models to assess associations with mortality and exposure to nitrogen dioxide (NO2) among ~735,600 adults in 10 of the largest Canadian cities. We estimated exposure contrasts partitioned into within- and between-city contrasts, and the sum of these as overall exposures, for every year from 1984 to 2006. Residential histories allowed us to follow subjects annually during the study period. We calculated hazard ratios (HRs) adjusted for many personal and contextual variables. In fully-adjusted, random-effects models, we found positive associations between overall NO2 exposures and mortality from non-accidental causes (HR per 5 p.p.b.: 1.05; 95% confidence interval (CI): 1.03-1.07), cardiovascular disease (HR per 5 p.p.b.: 1.04; 95% CI: 1.01-1.06), ischaemic heart disease (HR per 5 p.p.b.: 1.05; 95% CI: 1.02-1.08) and respiratory disease (HR per 5 p.p.b.: 1.04; 95% CI: 0.99-1.08), but not from cerebrovascular disease (HR per 5 p.p.b.: 1.01; 95% CI: 0.96-1.06). We found that most of these associations were determined by within-city contrasts, as opposed to by between-city contrasts in NO2. Our results suggest that variation in NO2 concentrations within a city may represent a more toxic mixture of pollution than variation between cities.

ObjectivesThe objective of this study was to compare occupational variation of the risk of bladder cancer in the Nordic countries and Canada.MethodsIn the Nordic Occupational Cancer study (NOCCA), 73 653 bladder cancer cases were observed during follow-up of 141.6 million person-years. In the Canadian Census Health and Environment Cohort (CanCHEC), 8170 cases were observed during the follow-up of 36.7 million person-years. Standardised incidence ratios with 95% CI were estimated for 53 occupations in the NOCCA cohort and HR with 95% CIs were estimated for 42 occupations in the CanCHEC.ResultsElevated risks of bladder cancer were observed among hairdressers, printers, sales workers, plumbers, painters, miners and laundry workers. Teachers and agricultural workers had reduced risk of bladder cancer in both cohorts. Chimney-sweeps, tobacco workers and waiters had about 1.5-fold risk in the Nordic countries; no risk estimates for these categories were given from the CanCHEC cohort.ConclusionWe observed different occupational patterns in risk of bladder cancer in Nordic countries and Canada. The only occupation with similarly increased risk was observed among sales workers. Differences in smoking across occupational groups may explain some, but not all, of this variation.

The 1991 Canadian Census Cohort is the largest population-based cohort in Canada (N=2,734,835). Prior to the creation of this Cohort, no national population-based Canadian cohort was available to examine mortality by socioeconomic indicators. The 1991 Canadian Census Cohort was created via the linkage of a sub-sample of respondents from the mandatory 1991 Canadian Census long-form to historical tax summary files, Canadian Mortality Database, Canadian Cancer Database, 1991 Health and Activity Limitation Survey and a sub-sample of the Longitudinal Worker File. Overall ascertainment of mortality and cancer is anticipated to be nearly complete and the Cohort is broadly representative of most groups in the Canadian population. The Cohort has been used to examine mortality outcomes by different indicators of socioeconomic status, occupational categories, ethnic groups, educational attainment, and for exposure to ambient air pollution. Results have shown that the estimated remaining years of life at age 25 differed substantially by income adequacy quintile, educational attainment, housing type and Aboriginal ancestry.

Background Sedentary behaviour is a potential risk factor for colorectal cancer. We examined the association between sedentary work, based on body position, and colorectal cancer risk in Canadians. Methods A working body position category (a. sitting; b. standing and walking; c. sitting, standing, and walking; d. other) was assigned to occupations reported by 1991 Canadian Census respondents based on national occupational counselling guidelines. Adjusted hazard ratios (HRs) and 95% confidence intervals (CI) were estimated for cancers of the colon (overall, proximal, and distal) and rectum in men and women newly diagnosed from 1992 to 2010. Results Compared to “sitting” jobs, men in occupations with “other” (non-sitting, −standing, or −walking) body positions had a weakly significant reduced colon cancer risk (HR = 0.93, 95% CI: 0.89, 0.98) primarily attributed to protection at the distal site (HR = 0.90, 95% CI: 0.84, 0.97). Men in “standing and walking” and “sitting, standing, and walking” jobs did not have significantly reduced colon cancer risks. No effects were observed for rectal cancer in men or colon and rectal cancer in women. Conclusion The two significant findings of this analysis should be followed-up in further investigations with additional information on potential confounders. Null findings for rectal cancer were consistent with other studies.

Living in a community with lower socioeconomic status is associated with higher mortality. However, few studies have examined associations between community socioeconomic characteristics and mortality among the First Nations population.The 1991-to-2006 Census Mortality and Cancer Cohort follow-up, which tracked a 15% sample of Canadians aged 25 or older, included 57,300 respondents who self-identified as Registered First Nations people or Indian band members. The Community Well-Being Index (CWB), a measure of the social and economic well-being of communities, consists of income, education, labour force participation, and housing components. A dichotomous variable was used to indicate residence in a community with a CWB score above or below the average for First Nations communities. Age-standardized mortality rates (ASMRs) were calculated for First Nations cohort members in communities with CWB scores above and below the First Nations average. Cox proportional hazards models examined the impact of CWB when controlling for individual characteristics.The ASMR for First Nations cohort members in communities with a below-average CWB was 1,057 per 100,000 person-years at risk, compared with 912 for those in communities with an above-average CWB score. For men, living in a community with below-average income and labour force participation CWB scores was associated with an increased hazard of death, even when individual socioeconomic characteristics were taken into account. Women in communities with below-average income scores had an increased hazard of death.First Nations people in communities with below-average CWB scores tended to have higher mortality rates. For some components of the CWB, effects remained even when individual socioeconomic characteristics were taken into account.

Background Agricultural workers may be exposed to potential carcinogens including pesticides, sensitizing agents and solar radiation. Previous studies indicate increased risks of hematopoietic cancers and decreased risks at other sites, possibly due to differences in lifestyle or risk behaviours. We present findings from CanCHEC (Canadian Census Health and Environment Cohort), the largest national population-based cohort of agricultural workers. Methods Statistics Canada created the cohort using deterministic and probabilistic linkage of the 1991 Canadian Long Form Census to National Cancer Registry records for 1992–2010. Self-reported occupations were coded using the Standard Occupational Classification (1991) system. Analyses were restricted to employed persons aged 25–74 years at baseline (N = 2,051,315), with follow-up until December 31, 2010. Hazard ratios (HR) and 95% confidence intervals (CI) were modeled using Cox proportional hazards for all workers in agricultural occupations (n = 70,570; 70.8% male), stratified by sex, and adjusted for age at cohort entry, province of residence, and highest level of education. Results A total of 9515 incident cancer cases (7295 in males) occurred in agricultural workers. Among men, increased risks were observed for non-Hodgkin lymphoma (HR = 1.10, 95% CI = 1.00–1.21), prostate (HR = 1.11, 95% CI = 1.06–1.16), melanoma (HR = 1.15, 95% CI = 1.02–1.31), and lip cancer (HR = 2.14, 95% CI = 1.70–2.70). Decreased risks in males were observed for lung, larynx, and liver cancers. Among female agricultural workers there was an increased risk of pancreatic cancer (HR = 1.36, 95% CI = 1.07–1.72). Increased risks of melanoma (HR = 1.79, 95% CI = 1.17–2.73), leukemia (HR = 2.01, 95% CI = 1.24–3.25) and multiple myeloma (HR = 2.25, 95% CI = 1.16–4.37) were observed in a subset of female crop farmers. Conclusions Exposure to pesticides may have contributed to increased risks of hematopoietic cancers, while increased risks of lip cancer and melanoma may be attributed to sun exposure. The array of decreased risks suggests reduced smoking and alcohol consumption in this occupational group compared to the general population. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3346-x) contains supplementary material, which is available to authorized users.

The purpose of this project was to examine the emotional health and well-being of Canadian caregivers of persons with significant mental health or addictions problems. We assessed the emotional health of caregivers by care-receiver condition type (i.e. mental health or addictions vs. physical or other health problems), levels of caregiver stress and methods particularly for reducing stress among caregivers of persons with mental health or addictions disorders. Weighted cross-sectional data from the 2012 General Social Survey (Caregiving and Care Receiving) were modelled using weighted descriptive and logistic regression analyses to examine levels of stress and the emotional health and well-being of caregivers by care-receiver condition type. Caregivers of persons with mental health or addictions problems were more likely to report that caregiving was very stressful and that they felt depressed, tired, worried or anxious, overwhelmed; lonely or isolated; short-tempered or irritable; and resentful because of their caregiving responsibilities. The results of this study suggest that mental health and addictions caregivers may experience disparate stressors and require varying services and supports relative to caregivers of persons with physical or other health conditions.

Background: Few cohort studies have evaluated the risk of mortality associated with long-term exposure to fine particulate matter [≤ 2.5 μm in aerodynamic diameter (PM2.5)]. This is the first national-level cohort study to investigate these risks in Canada. Objective: We investigated the association between long-term exposure to ambient PM2.5 and cardiovascular mortality in nonimmigrant Canadian adults. Methods: We assigned estimates of exposure to ambient PM2.5 derived from satellite observations to a cohort of 2.1 million Canadian adults who in 1991 were among the 20% of the population mandated to provide detailed census data. We identified deaths occurring between 1991 and 2001 through record linkage. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for available individual-level and contextual covariates using both standard Cox proportional survival models and nested, spatial random-effects survival models. Results: Using standard Cox models, we calculated HRs of 1.15 (95% CI: 1.13, 1.16) from nonaccidental causes and 1.31 (95% CI: 1.27, 1.35) from ischemic heart disease for each 10-μg/m3 increase in concentrations of PM2.5. Using spatial random-effects models controlling for the same variables, we calculated HRs of 1.10 (95% CI: 1.05, 1.15) and 1.30 (95% CI: 1.18, 1.43), respectively. We found similar associations between nonaccidental mortality and PM2.5 based on satellite-derived estimates and ground-based measurements in a subanalysis of subjects in 11 cities. Conclusions: In this large national cohort of nonimmigrant Canadians, mortality was associated with long-term exposure to PM2.5. Associations were observed with exposures to PM2.5 at concentrations that were predominantly lower (mean, 8.7 μg/m3; interquartile range, 6.2 μg/m3) than those reported previously.

Background: It may be possible to avoid malleolar osteotomy for treatment of osteochondral talar lesions with chondrocyte transplantation techniques, where perpendicular approach to the talar surface is not required. We hypothesized that limited anterior distal tibial plafondplasty would allow access to most of the talar surface. We compared talar access with soft tissue exposure versus plafondplasty. Methods: Two soft tissue exposures (anteromedial and anterolateral) and two limited anterior distal tibial plafondplasties (anteromedial and anterolateral) were used on 12 cadaver lower-extremity specimens. Digital analysis was used to assess the accessible area. Results: Percentage of total talar dome surface area access increased significantly between soft tissue exposure and limited plafondplasty medially (22.3 ± 6.3% versus 37.9 ± 4.6%; p < 0.001) and laterally (22.4 ± 7.7% versus 37.9 ± 7.7%; p < 0.001). Percentage sagittal plane access also increased significantly between soft tissue exposure and limited plafondplasty medially 54.4 ± 12.0% versus 81.3 ± 9.7%; p < 0.001) and laterally (53.3 ± 14.5% versus 80.9 ± 12.8%; p < 0.001). Limited exposure to an additional 14.2 ± 5% of the total talar surface area was possible. The posterior 10.6 ± 8% was inaccessible. Conclusions: A soft tissue approach with limited plafondplasty provided adequate exposure for the majority of the medial and lateral talar surface. Only the central posterior 10% of the talus was not accessed by this method. Clinical Relevance: It may be possible to avoid malleolar osteotomy by using limited plafondplasty to access the talar dome for treatment of osteochondral lesions if perpendicular access to the talus is not required.

Most studies on the association between exposure to fine particulate matter (PM2.5) and mortality have considered only total concentration of PM2.5 or individual components of PM2.5 and not the combined effects of concentration and particulate composition. We sought to develop a method to estimate the risk of death from long-term exposure to PM2.5 and the distribution of its components, namely: sulphate, nitrate, ammonium, organic mass, black carbon and mineral dust. We decomposed PM2.5 exposure into the sum of total concentration and the proportion of each component. We estimated the risk of death due to exposure using a cohort of ~2.4 million Canadians who were followed for vital status over 16 years. Modelling the concentration of PM2.5 with the distribution of the proportions of components together was a superior predictor for mortality than either total PM2.5 concentration alone, or all component concentrations modelled together. Our new approach has the advantage of characterizing the toxicity of the atmosphere in its entirety. This is required to fully understand the health benefits associated with strategies to improve air quality that may result in complex changes not only in PM2.5 concentration, but also in the distribution of particle components.

Background . Injury is the leading cause of death for young people in Canada. For those living in the northern territories (Yukon, Nunavut, and the Northwest Territories), injury represents an even greater problem, with higher rates of injury for people of all ages in northern areas compared with the rest of Canada; however, no such comparative studies have focussed specifically on non-fatal injury in youth. Objectives . To profile and examine injuries and their potential causes among youth in the northern territories as compared with other parts of Canada. Design . Cross-sectional data from the 2009/2010 Health Behaviour in School-aged Children survey (youth aged 11–15 years) were examined for the Canadian northern territories and the provinces (n=26,078). Individual survey records were linked to community-level data to profile injuries and then study possible determinants via multilevel regression modelling. Results . The prevalence of injury reported by youth was similar in northern populations and other parts of Canada. There were some minimal differences by injury type: northern youth experienced a greater percentage of neighbourhood (p

A short-term isometric exercise protocol was tested in ten hypertensive individuals to determine its efficacy as a high blood pressure-reducing intervention.The study was a prospective case study of 10 hypertensive individuals (8 men, 2 woman, mean age = 52 + 5 years) who underwent six weeks of isometric exercise training (three sessions/week).Blood pressure, blood lipids and markers of oxidative stress were monitored before, during and following the isometric intervention. Electron spin resonance spectroscopy was used to directly measure radicals in the blood samples.After six weeks, systolic blood pressure decreased an average 13 mm Hg (p0.05) from a mean blood pressure of 146 to 133 mm Hg, a level that is below the usual 140 mm Hg hypertension threshold. Blood lipids were unchanged, but markers of oxidative stress were affected, with a dramatic decrease in exercise-induced oxygen centered radicals (-266%), (p0.05) and an increased resting whole blood glutathione:oxidized glutathione (+61%) in hypertensive adults following six weeks of isometric exercise.Six weeks of isometric exercise training was effective in lowering systolic but not diastolic blood pressure in pre-hypertensive and hypertensive individuals, and enhanced antioxidant protection is a likely underlying mechanism.

Following preliminary evidence from observational studies, we test the potential relationship between whole-body vibration (WBV) and prostate cancer in a cohort study.WBV exposure was assigned based on occupation in 1991 and 1,107,700 participants were followed for incident prostate cancer until the end of 2003. Adjusted hazard rate ratios (HRs) were calculated using Cox proportional hazards modeling.17,922 incident prostate cancer cases were observed. WBV-exposed men in Natural and Applied Sciences Occupations had a 37% elevated risk of prostate cancer (95% CI 1.09-1.72) and WBV-exposed men in Trades, Transport, and Equipment Operators Occupations had a 9% reduced risk (95% CI 0.86-0.97). Independent of WBV exposure, small but significant differences in risk were seen for several occupational categories.We found no consistent relationship between WBV and prostate cancer. Further research could focus on other exposures or specific occupations in the studied categories to determine what may be contributing to the observed differences in prostate cancer risk.

Using multiple-cause-of-death data, this study examines diabetes mellitus as a cause of mortality. During the 2004-to-2008 period, diabetes mellitus was listed as either the underlying cause or a contributing cause of 119,617 deaths. It was more than twice as likely to be a contributing than the underlying cause of death. When it was identified as the underlying cause of death, diabetes mellitus was rarely the only cause. The diabetes mellitus mortality rate was relatively high among males, older individuals, and people living in lower-income neighbourhoods. Provincial/Territorial differences in rates of death from diabetes mellitus were considerable. When diabetes mellitus was the underlying cause of death, cardiovascular diseases were listed as a contributing cause most often, and when diabetes mellitus was a contributing cause, cardiovascular diseases were most likely to be the underlying cause.

Finger fillet flaps have been used to treat a variety of complex hand deformities providing stable soft tissue coverage and preventing pathologic contractures. Fillet flaps have not been reported in the coverage of segmental extensor tendon deficit in an adjacent digit. A 20-year-old man involved in a motor vehicle crash sustaining a 30% total body surface area burn, primarily to left arm and bilateral lower extremities. In particular, his left index finger extensor mechanism was disrupted with exposure of the proximal interphalangeal (PIP) joint. In addition, the middle finger had a segmental exposure of the extensor tendon. The nonfunctional index finger was sacrificed to provide coverage, via a forked fillet finger flap, of the exposed extensor tendon at the PIP and metacarpophalangeal (MCP) joints. Total active motion of left fingers at 12 months consisted of the third digit 0 to 86 degrees at the MCP joint, 0 to 88 degrees at the PIP joint and 0 to 33 degrees at the distal interphalangeal joint. Gross grip strength improved to 26 lb at 1 year follow-up. Adequate soft tissue coverage of extensor tendons can be challenging in the traumatic hand. With this novel approach of a forked finger fillet flap we were able to provide adequate soft tissue coverage of exposed tendons and joints improving the patient's strength and active range of motion especially in the middle finger. Prevention of postburn boutonnière deformity was an additional benefit.

Many First Nations children live in communities that face diverse social and health challenges compared with their non-Aboriginal peers, including some of the most socio-economically challenging situations in Canada. These differences can be seen in broad indicators of the social determinants of health. Studies of mortality in Aboriginal populations across Canada are often restricted by the lack of Aboriginal identifiers on national death records. While some studies have utilised a record-linkage approach, this is often not possible for the entire country or for recent data. Some researchers have adopted a geographic approach and examined mortality and morbidity in areas that have a high percentage of Aboriginal identity residents, and have uniformly reported elevated rates of mortality and morbidity compared with other areas. The purpose of this article was to examine child and youth mortality (aged 1 to 19 years) in areas where a high percentage of the population identified as First Nations in comparison with areas where there is a low percentage of Aboriginal identity residents.Using a geographic threshold table approach, areas with a high percentage of Aboriginal identity peoples were classified as either First Nations, Métis, or Inuit communities based on the predominant identity group. The upper one-third of the total Aboriginal population distribution was used as a cut-off for high percentage First Nations areas, where 97.7% of the population aged 1-19 were of First Nations identity in 2006 (Age-standardized mortality rates for children and youth in high-percentage First Nations identity areas were significantly higher than in low-percentage Aboriginal identity areas. The rate ratio for all-cause mortality for boys was 3.2 (CI: 2.9-3.6) for 2005-2007 and 3.6 (CI: 3.2-4.2) for girls. Mortality rates for injuries had the largest difference, with rate ratios of 4.7 (CI: 4.0-5.5) and 5.3 (CI:4.5-6.3) for boys in 2000-2002 and 2005-2007 and 5.5 (CI: 4.4-6.8) and 8.3 (CI: 6.8-10.1) for girls in the same period.A strength of this study is that it is the first to use national-level vital statistics registration data across two time periods to report mortality by cause for children and youth living in high-percentage First Nations areas. Vital events were geographically coded to high-percentage First Nations identity areas and compared with low-percentage Aboriginal identity areas at the Dissemination Areas level. This area-based methodology allows for mortality to be calculated for children and youth by sex and by detailed cause of death for multiple time periods. The results provide key evidence for the persistent differences in the causes of death for children and youth living in high-percentage First Nations identity areas.

Because Vital Statistics data do not include information on Inuit identity in all jurisdictions, mortality rates cannot be calculated specifically for Inuit. However, Inuit in Canada are geographically concentrated--78% live in Inuit Nunangat, and 82% of the area's total population identify as Inuit. While there are limitations, geographic approaches can be employed to calculate mortality for the population of that area.The Vital Statistics Database (1994 to 2008) and population estimates were used to calculate age-standardized mortality rates (ASMRs) in five-year intervals around the 1996 and 2006 Census years. Mortality rates were calculated for 1- to 19-year-olds living in Inuit Nunangat and those living elsewhere in Canada.The ASMR in 2004-2008 for 1- to 19-year-olds in Inuit Nunangat was 188.0 deaths per 100,000 person-years at risk, five times the rate (35.3) elsewhere in Canada. The disparity had not narrowed over the previous decade. In Inuit Nunangat, injuries were responsible for 64% of deaths of children and teenagers, compared with 36% in the rest of Canada.The persistently high mortality rates for children and teenagers living in Inuit Nunangat, compared with the rest of Canada, are important in understanding the health and socio-economic situation of residents of this region.

We conducted a study to compare 3 methods of measuring knee range of motion: visual estimation by physicians, hand goniometry by physical therapists, and radiographic goniometry. We hypothesized that reliability would be high within and across all techniques. We found intrarater and interrater reliability to be satisfactory for visual estimation, hand goniometry, and radiographic goniometry. Interrater reliability across methods did not agree satisfactorily. Between-methods differences in estimating knee range of motion may result from variations in technique among physicians and physical therapists.

HIV-1 circulates within an infected host as a genetically heterogeneous viral population. Viral intrahost diversity is shaped by substitutional evolution and recombination. Although many studies have speculated that recombination could have a significant impact on viral phenotype, this has never been definitively demonstrated. We report here phylogenetic and subsequent phenotypic analyses of envelope genes obtained from HIV-1 populations present in different anatomical compartments. Assessment of env compartmentalization from immunologically discrete tissues was assessed utilizing a single genome amplification approach, minimizing in vitro -generated artifacts. Genetic compartmentalization of variants was frequently observed. In addition, multiple incidences of intercompartment recombination, presumably facilitated by low-level migration of virus or infected cells between different anatomic sites and coinfection of susceptible cells by genetically divergent strains, were identified. These analyses demonstrate that intercompartment recombination is a fundamental evolutionary mechanism that helps to shape HIV-1 env intrahost diversity in natural infection. Analysis of the phenotypic consequences of these recombination events showed that genetic compartmentalization often correlates with phenotypic compartmentalization and that intercompartment recombination results in phenotype modulation. This represents definitive proof that recombination can generate novel combinations of phenotypic traits which differ subtly from those of parental strains, an important phenomenon that may have an impact on antiviral therapy and contribute to HIV-1 persistence in vivo .

Objectives. The objective of this article is to measure the contributions of age groups and causes of death to differences in mortality and life expectancy between residents of Inuit Nunangat and the rest of Canada. Study design. The geographic area of coverage includes communities within Inuit Nunangat, with the addition of Inuvik in the Northwest Territories. Deaths were compiled for 2 5-year periods, 1994 through 1998 and 1999 through 2003, with the mid-year centred on the 1996 and 2001 censuses. Methods. Abridged life tables were constructed according to the revised Chiang method. Age decomposition of differences in life expectancy and cause-deleted life tables were calculated using a discrete approach. The age groups and causes contributing to differences in life expectancy between Inuit Nunangat and the rest of Canada were calculated. Results. Specific age groups contribute more to the difference in life expectancy between Inuit Nunangat and the rest of Canada. For males, over 50% of the difference in life expectancy is due to excess mortality before 25 years of age, while for females nearly 65% is due to excess mortality after the age of 60. Conclusions. Cancer is a major contributor to the difference in life expectancy between residents of Inuit Nunangat and the rest of Canada; reduction in cancer rates would make the greatest contribution to gains in life expectancy. There are clear gender differences in life expectancy and mortality, with the total effect of mortality being greatest for males between 15 and 25 years of age and for females over the age of 60. (Int J Circumpolar Health 2010; 69(1):38-49) Keywords: Inuit, Canada, life expectancy, mortality, Inuit Nunangat

Because of their favorable effects on renal hemodynamics, calcium antagonists may have a major role in the prevention and management of certain types of acute renal dysfunction. In fact, verapamil (VP) was shown to prevent cyclosporin A (CsA)-induced decreases in RBF in mice and in cadaver renal transplant (CRT) recipients. The study presented here of 59 cadaver renal transplant patients evaluates the outcome from perioperative treatment with VP (N = 30) administered intraoperatively into the renal artery (10 mg) followed by oral administration of 120 mg every 8 to 12 h for 14 days versus no drug (N = 29). Early immunosuppression included azathioprine, corticosteroids, and antilymphocyte globulin with subsequent overlapping with CsA on days 5 and 6. Actuarial graft survival at 1 yr was different when the two groups were compared (P less than 0.05). Estimated graft survival at 1 yr for VP patients was 93.3 compared with 72.4% in control patients. The improved graft survival was most striking in repeat transplants with 90% graft survival at 1 yr for VP recipients versus 37.5% for controls. Compared with controls, VP recipients had significantly improved renal parenchymal diastolic blood flow velocities on the first day after surgery (7.8 versus 5.8 cm/s). By day 7, GFR were greater with VP (44 +/- 29 mL/min) versus controls (28 +/- 22 mL/min). Of VP patients, 67% (18 of 24) had GFR greater than 30 mL/min versus 33% (9 of 26) for control patients. Similarly, on the seventh day, 77% (21 of 30) of VP patients had serum creatinines less than 2.0 mg% versus 34% (10 of 29) for controls.(ABSTRACT TRUNCATED AT 250 WORDS)

The records of 280 patients who underwent pelvic lymphadenectomy and radical cystectomy for transitional cell carcinoma of the bladder between 1971 and 1986 were reviewed. A total of 42 patients had either 1 (stage pN1) or more than 1 (stage pN2) positive lymph nodes (20 and 22 patients, respectively). The over-all 3-year survival rate for patients with positive lymph nodes was 27%, and it was 30 and 18.5% for stages pN1 and pN2 disease, respectively. Kaplan-Meier survival curves revealed a sustained survival advantage for stage pN1 over pN2 disease for the first 3 years (p less than 0.05) but the difference was not significant at 5 years of followup. Eleven patients with negative lymph nodes but local extension of tumor into the prostatic stroma and/or ducts had a 5-year survival rate of 36%, which equaled the survival of 49 stage pT3b,pN0 cancer patients in the same series. Surgical mortality for the entire population of 280 patients was 2.1% and there was no increase in mortality or morbidity among the node positive patients. Based on the findings of improved survival of stages pN1 and pT3b,N0 cancer patients compared to stage pN2 cancer patients, the tumor, nodes and metastasis classification offers more specific prognostic information than does a single designation of Jewett stage D disease.

Human immunodeficiency virus type 1 (HIV-1) R5 isolates that predominantly use CCR5 as a coreceptor are frequently described as macrophage tropic. Here, we compare macrophage tropism conferred by HIV-1 R5 envelopes that were derived directly by PCR from patient tissue. This approach avoids potentially selective culture protocols used in virus isolation. Envelopes were amplified (i) from blood and semen of adult patients and (ii) from plasma of pediatric patients. The phenotypes of these envelopes were compared to those conferred by an extended panel of envelopes derived from brain and lymph node that we reported previously. Our results show that R5 envelopes vary by up to 1,000-fold in their capacity to confer infection of primary macrophages. Highly macrophage-tropic envelopes were predominate in brain but were infrequent in semen, blood, and lymph node samples. We also confirmed that the presence of N283 in the C2 CD4 binding site of gp120 is associated with HIV-1 envelopes from the brain but absent from macrophage-tropic envelopes amplified from blood and semen. Finally, we compared infection of macrophages, CD4+T cells, and peripheral blood mononuclear cells (PBMCs) conferred by macrophage-tropic and non-macrophage-tropic envelopes in the context of full-length replication competent viral clones. Non-macrophage-tropic envelopes conferred low-level infection of macrophages yet infected CD4+T cells and PBMCs as efficiently as highly macrophage-tropic brain envelopes. The lack of macrophage tropism for the majority of the envelopes amplified from lymph node, blood, and semen is striking and contrasts with the current consensus that R5 primary isolates are generally macrophage tropic. The extensive variation in R5 tropism reported here is likely to have an important impact on pathogenesis and on the capacity of HIV-1 to transmit.

Wound healing after major joint surgery involves a series of complex events. Over the past several years, thrombin has emerged as a pivotal participant in wound healing. The high incidence of venous thromboembolism following major joint replacement has made prophylaxis with pharmacologic agents a component of postoperative management. Anticoagulant agents of various classes affect different degrees of thrombin inhibition by virtue of their in vivo mechanisms of action. By inhibiting thrombin activity directly, with or without antithrombin III Or other antithrombins, traditional anticoagulants may retard the wound healing process and impair completion. Newer, more selective anticoagulants may provide not only more effective alternatives for venous thromboembolism prophylaxis surrounding major orthopedic procedures, but also an anticoagulant environment more favorable to wound healing.

The 20-year performance of metal-on-metal hip articulations has not been reported. Five McKee—Farrar total hip prostheses and one Sivash prosthesis were obtained at revision surgery after a mean implantation time of 21.3 years. A radiographic, histologic, implant, and wear analysis was performed on these total hip implants with cobalt—chrome metal-on-metal articulations. All cases were associated with femoral component loosening, but the bearing surfaces performed remarkably well. The worst case estimate of combined femoral and acetabular linear wear was 4.2 μm per year, about 25 times less than that typically seen with polyethylene. Metal particles and foreign-body inflammation were seen in all cases, but the volume of reactive tissue was small compared with what is generally seen at revision of hips with a polyethylene acetabular bearing. This may be due to a reduced particle burden or a decreased inflammatory reaction to particulate metal, or both. In addition to articular wear, other sources of metal particles included femoral neck impingement on the acetabular rim, stem burnishing, and corrosion. Prosthetic hip reconstructions can fail for many reasons, including suboptimal femoral stem and/or acetabular cup design and/or fixation. By today's standards, the McKee—Farrar and Sivash stem and acetabular component designs are suboptimal; however, after more than 20 years of use, the metal-on-metal bearing surfaces in these cases demonstrated low wear and do not appear to be the cause of failure. Recent advances in total hip arthroplasty, which include improved implant design, materials, manufacturing, and fixation, combined with a better understanding of the mechanisms of implant loosening and failure, suggest that the cobalt—chrome metal-on-metal bearing be reexamined as an alternative to polyethylene when exceptional durability is required.

To document more clearly the effect of selective medical treatment on the course of nephrolithiasis, we surveyed 103 consecutive patients being followed in our stone clinic. Of the patients who initially had existing stones within the kidneys 69 per cent experienced no symptoms while undergoing medical therapy, compared to 96 per cent of those who had no existing stones. In all subjects studied new stone formation was reduced in more than 95 per cent and no new stones were formed in more than 75 per cent. An operation for newly formed calculi was necessary in only 2 per cent of the patients on medical therapy, whereas 58 to 69 per cent of the patients required an operation for new stones before beginning medical treatment. We believe that selective medical treatment has an important role in the over-all management of nephrolithiasis. Appropriate medical therapy may decrease significantly the number of new stones formed and may obviate the need for a repeat stone operation. Therefore, medical treatment should be an important adjunct to percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy.

During the first 2 weeks after birth, infant rats were subjected to a schedule of localized X-irradiation, which has been shown to produce substantial decrease in cell number in the dentate gyrus. In contrast to reports of surgically lesioned rats, we observed hyperactivity in young X-irradiated rats as measured by revolutions of a running wheel. This hyperactivity occurred mainly at night. When isolated in a home cage, and then confronted with an intruder rat, adult hippocampal rats boxed, mounted, and showed dominance postures at a greater frequency than did controls. The hippocampal rats did not fight more, however. These results suggest that hippocampal rats overrespond to normal stimuli.

Numerous studies have examined the association of air pollution with preterm birth and birth weight outcomes. Traffic-related air pollution has also increasingly been identified as an important contributor to adverse health effects of air pollution. We employed a national nitrogen dioxide (NO2) exposure model to examine the association between NO2 and pregnancy outcomes in Canada between 1999 and 2008. National models for NO2 (and particulate matter of median aerodynamic diameter

The change in the position of the kidney during percutaneous nephrostomy is a major concern to urologists who participate in percutaneous stone removal. We report that the majority of kidneys ascend an average of 2.2 cm. when the patient turns from a supine to a prone position. This change in position is more marked on the right side and is more common in male patients. Knowledge of this anatomical variation is important to determine which patients are suitable candidates for percutaneous nephrostolithotomy and to plan a percutaneous approach to a renal or ureteral calculus.

Two patients with rupture of the urethra secondary to sexual trauma are described. Our results with the surgical treatment of such injuries are reported and the potential etiologies are postulated. One patient had an excellent result, while the other had a residual urethral stricture.

Review of records between 1960 and 1981 revealed 15 cases of testicular rupture secondary to blunt scrotal trauma. Because of delay in presentation testicular salvage was accomplished in only 20 per cent of the cases. In 5 cases in which the patient was evaluated with radionuclide testicular imaging using 99mtechnetium pertechnetate the diagnosis of testicular rupture was made preoperatively.

Eight of 24 female rats fed 66.9 mg/kg-day of thiram developed neurotoxicity. The neurotoxic effects were characterized by ataxia and paralysis of the hind legs. There were demyelination, degeneration of the axis cylinders, and presence of macrophages in the nerve bundle of the sciatic nerve. Degeneration in the ventral horn of the lower lumbar region of the spinal cord was evidenced by chromatolysis of motorneurons, pyknosis, and satellitosis. During a second experiment, 4 of 24 females fed 65.8 mg/kg--day also developed ataxia and paralysis. An additional 9 females showed clasping of the hind feet when picked up by the tail. Nerve conduction could not be measured for one severely ataxic rat and the electromyogram indicated a loss of motor unit function. Histopathology of this rat, along with the others, suggests the peripheral nerve as the primary site of the lesion. Thiram also caused behavioral changes in apparently normal rats. The walking pattern of the hind legs was altered with decreases in stride width and the angle between contralateral steps. These rats required significantly more shock-motivations and cleared a lower height in a jump/climb ability test. An open-field study indicated that thiram caused hyperactivity in the nonataxic rats of both sexes. Three of 24 rats fed 95.8 mg/kg-day of ferbam also developed ataxia or paralysis. Images FIGURE 1. FIGURE 1. FIGURE 2. FIGURE 2. FIGURE 4. FIGURE 5. FIGURE 6. FIGURE 6. FIGURE 7. FIGURE 7.

A case of bilateral renal cell carcinoma associated with von Hippel-Lindau syndrome and treated successfully with staged bilateral nephrectomy and hemodialysis is reported. The literature is reviewed with special emphasis on early diagnosis based on family history. Hemodialysis is a logical treatment modality. This disease, unlike adult renal cell carcinoma, is multifocal and poorly treated with partial nephrectomy.

Cis-platinum as single agent therapy was investigated in 8 patients with stage D transitional cell carcinoma of the bladder. Dramatic responses were obtained in some patients and the quality of life was improved for as long as 8 months but no cures were obtained. Also noted was an occasional marked loss of renal function as measured by creatinine clearance despite a carefully managed protocol to avert this known side effect of cis-platinum (nephrotoxicity). No auditory problems were noted in these 8 patients.

The safety and analgesic efficacy of dezocine and morphine in the treatment of acute renal or ureteral colic due to calculi were evaluated in 2 multicenter, double-blind studies, comparing 10 mg. dezocine and 10 mg. morphine in 88 patients, and 15 mg. dezocine and 10 mg. morphine in 61 patients. All patients received an intramuscular injection of the test drug, and pain intensity and pain relief were evaluated through 4 hours after drug administration. Vital signs, degree of sedation and adverse effects also were recorded. Mean efficacy scores were virtually identical for 10 mg. dezocine and 10 mg. morphine but 15 mg. dezocine produced consistently better analgesia than 10 mg. morphine. This superiority of 15 mg. dezocine was statistically significant on the pain analogue scale at 1 to 4 hours. More morphine-treated than dezocine-treated patients withdrew from each study because of inadequate pain relief. The frequency of adverse effects was not significantly different between groups in either study and none of the patients had clinically significant changes in vital signs. These results indicate that dezocine is a safe and effective analgesic for the treatment of renal and ureteral colic due to calculi, and 15 mg. dezocine were more effective than 10 mg. morphine in this pain model.

Previous investigators have shown that ultrasound is useful in assessing the transplanted kidney. Hydronephrosis may be reliably excluded. Although an increase in the measured volume of the renal transplant has been correlated with transplant rejection [1-3], parenchymal changes due to rejection have not been well documented. These findings are described and correlated with the arteriographic and anatomic changes in five patients, and are representative of findings seen in a larger series of approximately 180 transplant examinations per year.

Serum from 59 men with testicular masses was examined for the presence of human chorionic gonadotropin-beta. Results indicate: 1) In patients with testicular tumor human chorionic gonadotropin-beta serves as a sensitive and specific marker of tumor activity with an incidence of 28%. 2) Because human chorionic gonadotropin-beta levels correlate with response to therapy this test will be useful in selecting men for adjunctive irradiation or chemotherapy. 3) Radioimmunoassay for human chorionic gonadotropin-beta is far more sensitive and specific than conventional methods for detecting human chorionic gonadotropin production. 4) After unilateral orchiectomy for carcinoma of the testis elevated serum luteinizing hormone levels are common and may be unrelated to the presence or activity of residual tumor. 5) Human chorionic gonadotropin-beta-producing tumors were associated with increased estradiol and testosterone levels and significantly depressed serum follicle stimulating hormone levels in this series. 6) The prognostic implications of the presence of human chorionic gonadotropin-beta are not yet fully understood. The importance of this study is the fact that men with testicular tumors have a high incidence of human chorionic gonadotropin-beta secretion and this fact provides the physician with a powerful new tool for examining the various aspects of tumor activity. It also shows the feasibility for prospective screening of patients with a wide variety of neoplasms of differing histologic types.

We evaluated prospectively 506 consecutive patients who presented with a history of blunt trauma and hematuria. All patients initially underwent excretory urography and cystography. Of the 506 patients 25 had detectable urinary tract injuries that were confirmed either by the initial studies or by computerized tomography, angiography or direct intraoperative inspection. Diagnoses included 7 renal contusions, 7 renal lacerations (1 major and 6 minor), 1 renal artery, 3 intraperitoneal and 5 extraperitoneal bladder ruptures, and 2 urethral injuries. Of the 25 patients 21 presented with gross hematuria, including all of those with lower tract injuries. One of the 4 patients who presented with microhematuria was hospitalized in shock. Of the remaining 3 patients with microhematuria and no shock 1 had a minor renal laceration and 2 had renal contusions. All 3 patients were managed conservatively and all 3 were hospitalized chiefly for associated nonurological injuries. If the patients who presented with microhematuria and no shock were excluded from initial radiographic evaluation, 1 minor renal laceration and 2 renal contusions would have been missed. If we had added 1 more exclusion criterion, that of absence of major associated injuries, we would not have missed an injury.