摘要:

The effects of intermittent inhalation of 57 ppm nitric oxide (NO) were studied in eight anesthetized, ventilated pigs given a continuous infusion ofEscherichia coliendotoxin. Seven animals served as controls. By administering NO synchronized with inspiration and close to the orotracheal tube, measurable amounts of the toxic metabolite, NO2, in the inspiratory gas mixture were avoided. No direct systemic effects of NO inhalation were seen, but through counteracting pulmonary vasoconstriction, a fall in cardiac output was delayed. Nitric oxide effectively attenuated the initial peak rise in mean pulmonary artery pressure and resistance, both returning to control levels after cessation of NO. These effects were reproduced during later phases of endotoxemia, giving further proof to the role of gaseous NO as a selective pulmonary vasodilator. Nitric oxide diminished pulmonary shunting, but unimpaired oxygenation was preserved only during the first inhalation period. Leukocyte counts decreased drastically and platelet aggregation was enhanced, but after 1.5 hours of endotoxin infusion, platelet hyperaggregation was maintained in the NO group while it decreased in the control group.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Male Fischer 344 rats were orally fed one of four diets (Osmolite HN, Alitraq, Impact, and Purina rodent chow). After 6 days, jejunal mucosal nitrogen content and thickness were normal in all groups. After 7 days, challenge withEscherichia coliintraperitoneally demonstrated no difference in survival for any dietary group. In a second study, acute protein-calorie malnutrition was induced by administering 5% dextrose orally for 10 days. Animals were refed for 7 days with one of the four diets. Serum albumin concentrations and intestinal mucosal nitrogen content and thickness returned to normal with each refeeding program. Challenge withE. coliafter 7 days of refeeding, however, again demonstrated no difference in survival for any dietary group. Specialized enteral feeding products, containing additional amounts of arginine, glutamine, glutamate, RNA, and omega-3 fatty acids, are no more effective than a standard enteral feeding product or rat chow in maintaining intestinal anatomy or restoring anatomy following fasting. Furthermore, we found no survival advantage for the specialized products followingE. coliperitonitis.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Hyperglycemia and glucose intolerance are characteristic of both the metabolic responses to injury and normal aging. To evaluate the interaction of such changes we conducted hyperglycemic glucose clamp studies (2-hour) in previously healthy young (20 ± 4 years, Mean ± SD) and older (73 ± 9 years) trauma patients and volunteers (23 ± 1 and 68 ± 5 years), determining whole-body glucose disposal and insulin responses to hyperglycemia. Injury Severity Scores were similar in the young and older patient groups (range, 17–30). Plasma glucose levels were greater in patients than volunteers in both the basal and hyperglycemic periods. Basal serum insulin and C-peptide levels were similar among groups, but during hyperglycemia both were markedly higher in young patients than older (and both volunteer groups). Whole-body disposal of exogenous glucose was substantially lower in patients than volunteers and in the older groups. Aging has a major impact on postinjury metabolism, being associated with exaggerated glucose intolerance and diminished insulin responses to glucose infusion. These findings have important implications for the metabolic and nutritional care of older patients following trauma and during critical illness.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The need for simultaneous diagnosis and treatment of life-threatening intracranial mass lesions and intra-abdominal injury results in controversy over the appropriate triage of unconscious blunt trauma patients with stable vital signs. To aid in early decisions for these patients, a retrospective analysis of 290 patients with Glasgow Coma Scale (GCS) scores ≤8 and systolic blood pressures (SBP) >90 mm Hg was undertaken. The hypothesis of this study was that life-threatening abdominal injury frequently occurs in these patients and injuries cannot be consistently identified from vital signs alone. Data were analyzed for injury mechanism, SBP, heart rate (HR), Injury Severity Score (ISS), Revised Trauma Score (RTS), Abbreviated Injury Scale score for the abdomen and brain (A-AIS, CNS-AIS), and the need for emergent laparotomy. Patients with concurrent injuries were more likely to come from motor vehicle crashes than falls (p< 0.001). Although severe abdominal injuries (A-AIS ≤3) were frequently identified based on SBP and HR, the use of clinical signs alone resulted in more missed injuries than did using the results diagnostic peritoneal lavage (DPL). This study suggests that all unconscious normotensive blunt trauma patients undergo immediate DPL to prevent missing life-threatening injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The cases of eight patients who underwent elective surgery for blunt cardiac trauma are presented. All but one experienced multiple trauma and the median Injury Severity Score was 26 (range, 18–59). A posttraumatic cardiac defect was diagnosed from 1 day up to 6.5 years (median, 3 weeks) after the accident. These included mitral regurgitation (n = 4), ventricular septal defect (n =1). Elective cardiac surgery was performed from 4 weeks up to 12 years after the traumatic events (median, 18.5 months). A history of blunt chest trauma requires careful clinical follow-up supported by echocardiography in asymptomatic patients. Surgical therapy is performed according to standard techniques and the results are comparable with those of non-trauma surgery.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The study reported here evaluated the efficacy of antibiotics administered in two periods: preoperative only and additional doses postoperatively. There was no difference in developing surgical sepsis between the groups when they included antibiotics preoperatively and the severity of the trauma was minor (Abdominal Trauma Index [ATI] value < 25). Additionally, the result was the same when one of the injured organs was the colon, in contrast with past studies. One interesting point is related to the association of a Revised Trauma Index value > 20 with a colon wound: in the present study, this combination had a deleterious effect on the patients, always resulting in abdominal sepsis. Emphasis is placed on the economic benefits of the abolition of postoperative antibiotic use in patients with ATI score less than 25.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

From January 1983 through December 1990, we treated 703 patients with central craniofacial fractures. Among them 177 had maxillary fractures, with or without frontonasoethmoidal involvement. Of the 177, 151 patients were diagnosed in the acute stage. Using the Glasgow Coma Scale, these 151 patients were divided into three groups: group I (GCS score 13–15), 100 patients; group II (GCS score 9–12), 33 patients; group III (GCS score 3–8), 18 patients. The patterns of facial fractures were analyzed and surgically corrected after the following average postadmission lags: group I, 7.1 days; group II, 11.5 days; group III, 13.3 days. The average hospital stay for each group was: group I, 15.6 days; group II, 19.5 days; and group III, 27.2 days. The mean follow-up period was 12 months. The physiologic, functional and esthetic outcomes were assessed. Regardless of initial head injury severity, the outcomes in each group showed almost no statistically significant differences, and unnecessary extended hospital stays may be avoided by early surgical management.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Twenty-three children with displaced radial neck fractures were treated by percutaneous reduction with a Steinmann pin after closed reduction failed. Reduction was successfully accomplished in 20 patients. The average age at treatment was 10.5 years (range, 7–13 years). The average length of follow-up was 2.5 years (range, 1–6 years). According to the criteria of Steinberg et al., 14 children (70%) had a good result, three (15%) had a fair result, and three (15%) and a poor result. Percutaneous pin reduction of angulated and displaced radial neck head fractures are associated with severe displacement, a moderate rate of fair and poor results (30%) can be expected, despite treatment by percutaneous reduction with a Steinmann pin.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Goals and Objectives:To determine the incidence of sledding trauma in a northeastern Ontario community. Factors and behaviors associated with these events were also examined.DesignProspective cases series.SettingEmergency departments of the Sudbury General and Memorial Hospitals.PatientsAll patients arriving at the two emergency departments in Sudbury with an injury sustained while sledding were included in the study. Physicians completed data forms on each patient. Information was validated by review of the ER records. Follow-up was completed by telephone in one to two weeks to determine residual disability.ResultsA total of 101 patients were identified with sledding-related injuries. There was a higher incidence of injuries among males (59%); the mean age of injured patients was 16 years (range, 16–46 years). Injuries occurred most frequently on weekends (51%). GT-racers were the most common device used by injured sledders (44%). Most injuries occurred on non-designated sledding hills in the community (71%). Many of the injuries were mild with a mean Injury Severity Score of 2.3 (range, 1–16). However, 7 (7%) patients required hospital admission, while 58% required follow-up by either their either family physician or a specialist. Patients injured while sledding missed an average of 3.7 days of work or school.ConclusionsSledding injuries are uncommon emergency department problems in this community; however, serious injury and absenteeism from work or school may result. Most injuries appear to be preventable and strategies of prevention are discussed.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To examine the mechanisms of injury and death in a commercial airline disaster and to propose preventative safety measures based on this analysis.Data SourceDenver County Coroner's Office and the National Transportation Safety Board.Study SelectionThose patients suffering fatal injuries as a result of the Continental Flight 1713 Airline crash.Data ExtractionAutopsy records from the Denver County Coroner's Office were reviewed with the causes of death determined. In many instances there was significant injury to more than one anatomic region in a single individual, each analyzed independently.Data SynthesisThere were 28 fatalities; nine died of mechanical asphyxiation, one of a penetrating cranial injury, and 18 of blunt trauma. The blunt injuries were remarkably similar to the deceleration injuries seen in high-speed motor vehicle crashes. Head trauma was the most common fatal blunt injury, following by injuries to the chest and the abdomen. Thirty-six percent of the head injuries and 27% of the chest injuries had associated cervical and thoracic spine fractures, respectively. Analysis revealed a marked similarity in injury pattern sustained by seatmates, with a high incidence of fatal and serous injuries suffered by those passengers sitting in the front half of the airplane.ConclusionsFatal blunt injury secondary to deceleration forces was the most common cause of death seen in this analysis. The use of a lap belt restraint system alone is not adequate to protect passengers against these forces as shown convincingly in the automotive industry literature. What impact a better passenger restraint system may have had on survival in this disaster is unknown, however, at a minimum, it would have significantly improved survival for 6 of 28 passengers dying of isolated blunt head trauma. Minor alterations in aircraft design (secure bolting of passenger seats to the airplane superstructure) and passenger restraints (3-point lap and shoulder harness system) is proposed to positively influence survival during an airplane crash at negligible increased airline expense or passenger inconvenience.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID