Journal of the American College of Surgeons
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The frequency and effects of cytochrome P450 (CYP) 2C9 polymorphisms in patients receiving warfarin.
Warfarin sodium (warfarin) is commonly prescribed in surgical practice. Warfarin use is complicated by an unpredictable dose response that may be due in part to genetically determined differences in metabolic capacity. To better understand the interaction between genotype and response to warfarin therapy, we determined the frequency and functional effects of polymorphisms of the predominant cytochrome P450 subfamily responsible for warfarin metabolism (eg, CYP2C9) in an ethnically defined U.S. patient population. ⋯ CYP2C9 polymorphisms are common, associated with significant reductions in warfarin dose, and partly account for interpatient variability in warfarin sensitivity. As interactions between genetic factors and other variables that influence warfarin effect are more completely understood, CYP analysis may prove a useful adjunct for increasing the safety and efficacy of this agent.
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Current recommendations of the American College of Surgeons Advanced Trauma Life Support course is routine radiographic screening of the pelvis for all patients who suffer blunt torso trauma. The purpose of this study is to evaluate in a prospective manner the sensitivity of clinical examination as a screening modality for pelvic fractures in awake and alert blunt trauma patients. ⋯ 1) Clinical examination of the pelvis can reliably rule out significant pelvic fracture in the awake and alert blunt trauma patient. 2) The addition of routine A-P pelvic x-ray does not improve the sensitivity in diagnosis of surgically significant pelvic fractures nor does it have significant impact on outcomes of pelvic fracture patients. 3) Elevated ethanol level is not a contraindication to use of clinical examination as a screening modality for pelvic fractures in the awake and alert blunt trauma patient.