摘要:

BackgroundWe report on 40 patients with penetrating trauma to the external genitalia. Initial evaluation and management, operative findings, and treatment outcomes are reviewed.MethodsWe retrospectively reviewed the medical records of all patients presenting to our facility with penetrating trauma to the external genitalia since 1988.ResultsOf the 40 patients reviewed, 22 sustained isolated scrotal trauma, 10 sustained isolated penile trauma, and 8 had both scrotal and penile injuries. Twenty-nine of the 30 men with scrotal injuries underwent surgical exploration, and 21 of these were found to have injuries to the spermatic cord or testes (in 2 patients, bilateral injuries were noted). The testicular salvage rate was 35%. Penile trauma occurred in 18 patients. Eight corporal injuries and four urethral injuries were managed with debridement and primary repair. Erection and normal voiding was present in all men undergoing reconstruction who returned for follow-up. Thirty-eight percent of tested patients were positive for hepatitis B, C, or both. More than 60% of tested patients were legally intoxicated at the time of injury. Injuries separate from genitourinary trauma were identified in 72% of the men.ConclusionEarly surgical exploration with conservative debridement and primary repair of injured structures is recommended for most men who sustain penetrating injuries to the external genitalia. Selected patients with superficial injuries can be managed nonoperatively, but delayed wound complications are not uncommon. Although universal precautions are recommended for all patients, the high prevalence of hepatitis B and C in this group reemphasizes their importance. Long-term follow-up in this largely young, mobile, indigent population was poor.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo study the cerebrovascular reactivity to CO2after severe head injury to establish the clinical and prognostic relevance of CO2reactivity.MethodsCerebrovascular reactivity to CO2was studied in 20 patients with severe head injuries at 3.0 +/- 1.8 days after trauma onset. Two cerebral blood flow studies were performed to measure CO2reactivity: the first study in a condition of normocapnia and the second study in a condition of relative hypocapnia.ResultsGlobal reactivity was superimposable to that found in awake, normocapnic subjects and did not correlate with age and Glasgow Coma Scale score but was dependent on the type of brain lesion. Moreover, reactivity correlated with outcome in patients studied after the first 3 days after trauma.ConclusionsOur data suggest that cerebrovascular reactivity is (a) almost preserved after a severe head injury; (b) significantly influenced by type of brain lesion; (c) prognostically relevant only in patients studied after the first 3 days after trauma.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background, Materials and MethodsBecause there is no consensus regarding the necessity of imaging the cervical spine of patients who sustain a gunshot wound to the cranium, the cervical spinal radiographs of 53 consecutive patients with gunshot wounds to the cranium admitted to Hermann Hospital, a Level I trauma center, from January of 1993 to January of 1996, were reviewed.ResultsThe cervical spine radiographs of all 53 patients were negative.ConclusionsCervical spine injury is not associated with gunshot wound to the cranium. Therefore, patient management decisions/procedures, including endotracheal intubation, should not be delayed pending cervical spine imaging.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

In a prospective, randomized trial, minimally displaced distal radius fractures were divided into two groups:those treated with plaster immobilization for 1 week compared with 3 weeks. Functional Cooney scores were determined at 6 weeks, 3 months, 6 months, and 1 year. No statistical differences could be found in functional outcome between the groups at any time during the evaluation. Although patients did not allow immediate functional treatment in the presence of a fracture, we could not find any differences between 1 week or 3 weeks of plaster treatment. No further dislocation occurred, and all patients experienced eventful healing with good and excellent results in 92% of the cases. We believe, therefore, that only minimal immobilization is required in these fractures and that they should be mobilized as soon as comfort allows.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A review of childhood injuries at the Wesley Guild Hospital, a component of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria, showed that 1,471 patients seen in the children's emergency room during a period of 4 years (1992-1995) were there as a result of trauma, representing 9% of all patients seen. The case notes and accident and emergency cards of 1,224 were available for review. Ages ranged from 2 months to 15 years, with a mean of 6.9 years, and 40% of the patients were between 5 and 10 years of age. More males were affected than females, with a ratio of 1.5:1. Road traffic crashes were the most common causal factor, responsible for 324 injuries (26.5%). About 90% of these were pedestrians knocked down by automobiles and motorcycles. Passengers accounted for about 10% of the cases. Falls occurred in 305 patients (25%); 229 patients fell while on level ground either playing or running, accounting for 75%. There were 122 patients (10%) with misplaced foreign bodies; about 60% of these were recovered from the ears, and 26.3% from the nostrils. Edible seeds were the most common foreign bodies, followed by beads. Injuries from bites occurred in 108 patients, with dog and snake bites taking the lead. Burns, mainly from scalding, occurred in 89 patients. Other rare injuries were knife wounds, gunshot wounds, and injuries resulting from assaults. The home was the most common site of injury (570 patients, 46.7%) followed by streets or roadways (363 patients, 29.7%); 19.5% of injuries occurred at school. The most common anatomic region affected was the head and neck, followed by the limbs. One hundred ninety-seven patients (16%) had bony fractures, femurs being the most affected bone. Head injury was seen in 104 patients, representing 8.5%, although only 17 of these injuries were severe. There were 10 cases of abdominal injury and 9 cases of chest injury, representing 0.8 and 0.7%, respectively. Wound infection occurred in 6.4% of the patients. Death occurred in 19 patients, accounting for 1.6%; 10 of these patients had severe head injuries. Road traffic injuries and burns accounted for the greatest number of complications. The findings of this study suggest that trauma is an important factor in childhood morbidity and mortality in our environment, with road traffic injuries taking the lead. Preschool pedestrian children were most commonly affected, the majority of them on errands for their parents. We believe that the majority of these injuries are preventable.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo assess the cognitive knowledge decline among graduates of the Advanced Trauma Life Support (ATLS) program in Israel, to compare the rate of decline between surgeons and nonsurgeons, and to recommend appropriate timing for refresher courses.MethodsA prospective study based on multiple-choice question test results of 220 ATLS course graduates was conducted 3 to 60 months after course completion. These results were then compared with the examination results immediately after the course. A statistical model based on survival analysis was used to evaluate the decline pattern and extent and to compare the study groups.ResultsA significant decline of cognitive knowledge over time among ATLS graduates was demonstrated. This decline was significantly greater in the nonsurgical group. A critical point of 20% cognitive knowledge loss among 50% of the examined physicians was observed around the 180th week after completion of the course.ConclusionPhysicians taking the ATLS course lose a significant part of their acquired cognitive knowledge after 3.5 years. Surgeons retain their cognitive knowledge for longer periods of time. Based on the study results, the optimal timing for a refresher course is between 3 and 4 years after the initial ATLS course.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundGrowth hormone (GH) has been shown to promote wound healing and to improve protein metabolism in burned patients. Through immunomodulation, GH has also protected rats infected with Salmonella typhimurium and mice infected with Escherichia coli. In spite of advances in the management of patient care for those with thermal injuries, high mortality rates of burned patients as a result of infections are of special concern. An improvement in the resistance of burned patients to certain infections will make the beneficial role of GH very clear. In this study, therefore, the immunomodulating effects of recombinant human GH (rhGH) in thermally injured mice exposed to opportunistic herpesvirus infections were investigated.Methods(1) Burned mice, exposed to herpes simplex virus type 1 (HSV-1), were treated subcutaneously with rhGH (4 mg/kg) and observed for 21 days to determine the protective antiviral effect of rhGH. (2) Because of reports describing a lack of interferon-gamma (IFN-gamma) responsiveness in burned mice, the IFN-gamma-producing ability of the splenic mononuclear cells (SMNC) from burned mice treated with rhGH was examined. (3) Because the generation of burn-associated suppressor macrophages that can inhibit the IFN-gamma production by SMNC has been previously described, the suppressor cell activities of macrophages from burned mice treated with rhGH were examined.ResultsAfter exposure to lethal amounts of HSV-1, mice treated with rhGH displayed a reduced mortality rate compared with control mice treated with saline. SMNC from burned mice treated with rhGH produced IFN-gamma, whereas this cytokine was not produced by SMNC from burned mice treated with saline. Also, an inhibition of the generation of burn-associated suppressor macrophages was displayed in burned mice treated with rhGH.ConclusionExogenous administration of rhGH caused an improvement in the resistance of burned mice to HSV-1 infection. In burned mice treated with rhGH, the impaired IFN-gamma responsiveness was restored and the generation of burn-associated suppressor macrophages was inhibited. IFN-gamma, a typical antiviral cytokine induced by rhGH through the regulation of the suppressor macrophage generation, may therefore play a role in the protection of burned mice infected with a lethal amount of HSV-1.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundHighly concentrated solutions of sulfuric acid are available to unclog drains. We have noted a substantial number of both accidental and intentional cutaneous burns caused by these agents.MethodsA retrospective review was conducted of children and adults who sustained sulfuric acid burns over a 13-year period ending in May 1996. Reports of injuries related to drain cleaners filed with the United States Consumer Product Safety Commission between 1991 and 1995 were also reviewed.ResultsTwenty-one patients (13 children, 8 adults) sustained cutaneous burns caused by concentrated sulfuric acid solutions. In 8 instances, the burn was accidental, whereas in 13 cases, sulfuric acid was used as a weapon. Median total body surface area burned was 5% (range, 1-25%). Approximately 50% of burns involved the face and neck. Skin grafting was required in 14 patients (66%). It is estimated that nationwide approximately 3,000 injuries per year are related to drain cleaners and that one-third of these involve cutaneous burns.ConclusionHighly concentrated sulfuric acid drain cleaner can produce full-thickness cutaneous burns that require skin grafting in the majority of cases. Proper use of these agents and sequestering them from children may reduce accidental contact; however, their abuse as agents of assault remains a source of significant morbidity.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo prospectively evaluate the incidence of clinically significant bleeding, side effects, and cost of therapy in mechanically ventilated trauma patients at high risk for stress ulcers who received simplified omeprazole suspension (SOS).MethodsProspective, evaluative study in a Level I trauma center. Mechanically ventilated trauma patients admitted with at least one additional risk factor for stress ulcer development received SOS for stress ulcer prophylaxis.ResultsSixty trauma patients were enrolled. The mean Injury Severity Score was 27.3. After starting SOS, there were no cases of clinically significant upper gastrointestinal bleeding related to stress ulceration. Baseline pH was 3.3, and mean gastric pH after SOS was increased to 6.7 (p < 0.005). There were no adverse effects thought to be related to omeprazole suspension. Incidence of nosocomial pneumonia after beginning SOS was 28.3%. The cost of acquisition plus administration of SOS was $13.13 per day, whereas the cost of drug acquisition alone was $3.83 per day.ConclusionIn a prospective, evaluative study of 60 trauma patients who required mechanical ventilation and had at least one additional risk factor for stress ulcer development, omeprazole suspension prevented clinically significant gastrointestinal bleeding, maintained excellent control of gastric pH, produced no toxicity, and was the least costly medication alternative.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID