摘要:

The effects of acute head injury or subarachnoid hemorrhage on the cardiovascular system (CVS) are well known, but data are lacking on the effects of acute spinal cord injury (SCI) on the CVS. The clip compression SCI rat model was used to measure changes in the mean systemic arterial pressure (mSAP), cardiac output (CO), heart rate (HR), total peripheral resistance (TPR), and central venous pressure (CVP) after SCI. Three groups of five animals each were anesthetized with chloralose-urethane: one group underwent only the surgical procedures including laminectomy, and the other two received either a 2.3- or 53.0-gm injury at the Tl spinal cord segment for 1 minute. The CO was measured using the thermodilution technique. CVS parameters were measured before injury, and then at designated times for 135 minutes after SCI. Analysis of variance and paired t-test with significance at p=0.05 were used for analysis. There were no CVS changes as a result of anesthesia, operative time, or laminectomy alone. Cardiovascular system (CVS) changes occurred after the 2.3- and 53.0-gm. injuries but were significantly different only in the 53.0-gm injured animals. In this group mSAP increased from a preinjury value of 105 ± 8 mm Hg to 178 ± 11 mm Hg as a result of SCI, followed by a prolonged period of hypotension (46 ± 15 mm Hg) lasting until 135 min post SCI. The CO after SCI also decreased from 394 ± 22 to 218 ± 29 ml/min/kg with the TPR reaching a minimal level at 45 min post SCI (265 ± 23 to 213 ± 29 mm Hg/ml/ min gm wt), after which it returned to preinjury values. There were no significant changes in the CVP in either group. In the 53.0-gm group significant bradycardia (492 ± 7 to 356 ± 44 beats/min) was observed by 45 min and continued to decrease until 135 min after SCI. Thus the CVS showed two major alterations after severe SCI: post-traumatic hypotension, and a parallel decline in CO. There were no major changes in TPR, HR, or CVP, although HR ultimately declined. These findings suggest that the decline in CO was not entirely due to decreased sympathetic tone, but may also have resulted from direct myocardial injury, similar to that demonstrated after head injury or subarachnoid hemorrhage.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Trauma from high-speed motor vehicle accidents is a leading cause of death and disability. Most of these injuries could be prevented if the driver and occupants of motor vehicles wore seat belts or used other restraining devices. The injuries produced when an unrestrained occupant of a motor vehicle is ejected from that vehicle or impacts on a hostile surface at high speed occur in a reproducible pattern. The types of injuries sustained by drivers and front seat passengers are different and specific enough to allow one to identify drivers and passengers with confidence. Because of severe life-threatening injuries to the central nervous system, and thoracic and abdominal viscera, other serious injuries may be overlooked. Knowledge of the mechanism of injury and the role of the victim (i.e., driver or passenger) should lead to the prompt radiographic evaluation of all areas at risk. Our findings are based on a study of 250 drivers and 250 front seat passengers involved in motor vehicle accidents. We found distinct common injury patterns and radiographic findings in drivers and front seat passengers.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

To investigate the role of the IVP, we studied 139 patients with blunt abdominal trauma and hematuria. Multivariate analysis of clinical parameters was utilized in attempt to predict which patients would have abnormal IVP's and which would eventually require genitourinary operation. Thirty-four patients (25%) demonstrated abnormalities on IVP; however, no combination of clinical findings (including degree of hematuria) could reliably predict which patients would have abnormal IVP's. On the other hand, in 90% of the patients, the necessity for genitourinary operation could be reliably predicted based on: presence of blood at the urethral meatus, degree of hematuria, patient age, Injury Severity Score, and number of rib fractures. We conclude that to detect IVP abnormalities, IVP's need to be performed on all blunt trauma patients with hematuria. However, patients likely to have injuries requiring operative repair can be predicted. Those patients unlikely to have genitourinary injury requiring repair, therefore, may have IVP performed on a nonurgent basis.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Between January 1982 and May 1985, eight patients with avulsion fractures of tibial tuberosity were seen at the University of South Alabama Medical Center. All were boys, average age, 15 years 8 months. Six of eight had a positive history of Osgood-Schlatter disease. Seven patients underwent open reduction and internal fixation, one had closed reduction and cast. Followup ranged from 5 months to 3.5 years, averaging 19.5 months. All, except one who had lateral meniscectomy, regained practically full ROM and reported no pain or limitation of activities. No patient developed genu recurvatum deformity or leg length discrepancy due to the injury. Open reduction and internal fixation is the treatment of choice in displaced intra-articular fractures. Lateral parapatellar incision is a more direct approach to this fracture and is less likely to injure the infrapatellar branch of the saphenous nerve.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Thirty-five patients with 41 calcaneus fractures, seen at Cook County Hospital over a 3½-year period, underwent an open reduction and internal fixation of their fractures through a sinus tarsi incision. Bohler's angle averaged 6° preoperatively and 26° postoperatively. An additional measurement, the critical angle, was defined. This angle is a measurement of the congruency of the posterior facet. It facilitated the selection of patients for an open reduction as well as allowed a determination of the adequacy of restoration of the joint surfaces postoperatively. In this series the critical angle averaged 26° preoperatively and 1° postoperatively. Followup was possible in 73% of the patients. Almost all of the patients exhibited some degree of limitation of motion of the subtalar joint, but the reduction of the fracture fragments was maintained in all cases and secondary deformity and complaints did not develop.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Hyperglycemia among adult trauma patients with head injuries is a recognized phenomenon which has been shown to be associated with a poor prognosis when it takes the form of nonketotic hyperosmolar hyperglycemia. It is not known to what extent a similar phenomenon occurs in pediatric patients, although it is known that a child's physiologic response to injury, particularly to neurologic injury, is often different than an adult's. This study was undertaken to characterize the hyperglycemic response of children with closed head injury compared to children with a non-head injury, and to measure the extent to which the presence of hyperglycemia is associated with a poor outcome among children with severe head injury. Records for all children ages 2 to 12 years admitted to a major regional trauma center with closed head injury over a 6-year period were compared to the records of a control group of children hospitalized for a non-head injury. The hyperglycemic response was more common among those with head trauma, occurring in 40% compared to 5% of the controls (p<0.001); however, the level of hyperglycemia could not be associated with any indicator of outcome. The entity known as nonketotic hyperosmolar hyperglycemia did not occur in any of these patients. Apparently, the hyperglycemia associated with closed head injury in children is transient, does not need to be treated with insulin therapy, and in contrast to what has been demonstrated in adult trauma patients, does not predict patient outcome.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

To evaluate the incidence and types of atypical ski injuries, charts and X-rays of all patients brought to Pocono Hospital with ski injuries between October 1984 and March of 1985 were reviewed. Atypical injuries occurred in only 5% of those seeking medical attention, but accounted for 67% of those requiring immediate hospitalization. Prompt recognition is essential for proper treatment of these potentially life-threatening injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The injuries seen in 200 Afghan war wounded in the International Committee of the Red Cross (ICRC) hospital in Quetta are reported. Evacuation took several days and no proper initial first aid was available. Therefore few of those reaching us had serious multiple injuries. The anatomic distribution of wounds was remarkably similar to that seen in other conflicts: 38% of the injuries were caused by bullets, 50% by fragmentation weapons, and 10% by mines. Two thirds of the patients had limb injuries. Of all wounded, patients with fractures of long bones needed the greatest number of repeated operations and the longest hospitalization time. Twenty-five patients had abdominal or perineal wounds and 12 needed laparotomy. Of 25 with head injuries 14 had penetrating brain trauma. Thoracic, vascular, and burn injuries were rare. The eight patients with spinal cord injury could fortunately be referred to the ICRC rehabilitation center in Peshawar within a week. Wound sepsis was the major problem due to the extraordinarly long delay in the initiation of treatment. In spite of the often grossly infected wounds, radical debridement usually led to good recovery for most patients, with a hospital mortality rate of only 2.5%.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Unlike previous reports, in 123 patients with abdominal injury or surgery significant and persistent hypokalemia was observed only after traumatic or surgical injuries of the liver. On the contrary, in all other extrahepatic abdominal trauma or operations kalemia was normal. This discrepancy may be related to the much greater abundance, in comparison with other abdominal organs, of adrenergic endings present in the liver. Trauma to or surgery of the liver stimulates such fibers, which locally release proportionally large amounts of norepinephrine. The consequent stimulation of beta-adrenergic receptors enhances the transfer of potassium from the blood into the cells, even if the affinity of norepinephrine for such receptors is less than that of epinephrine. The frequent finding of kaliuria at the upper normal levels may suggest an accessory role of aldosterone in causing and maintaining this hypokalemia.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID