摘要:

One hundred twenty-three femoral shaft fractures were treated with Grosse-Kempf slotted, locked nails and followed for a median 20 (range, 12–60) months. There were eight intraoperative and 11 postoperative complications, among them two superficial and two deep infections. Most of the intraoperative complications and some postoperatively lost reductions could have been prevented by a better operative technique and judgment of stability. Seventy-eight results were graded as excellent, 24 as good, 19 as fair, and two as poor (one 9-cm shortening and one 40° external malrotation). All fractures united without further procedures during the first year.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

This study examined the frequency of spine and abdominal injuries to motor vehicle occupant crash victims, the relationship between the two types of injuries, and the association with restraint use. There were 303 motor vehicle occupants treated at a regional trauma center for spine and/or abdominal injuries over a 5-year period. Patients with Chance-type fractures of the lumbar spine were much more likely to be rear seat passengers and to be using a lap belt than were patients with other types of spinal injuries. Similarly, patients with hollow viscus injuries were more likely to be rear seat passengers and to be lap belted than were patients with injuries to the spleen, liver, pancreas, or kidneys. Nearly two thirds of the lumbar Chance-type fractures were associated with hollow viscus injuries, including six of seven children. This increased risk of Chance-type fractures and hollow viscus injuries was associated with increased use of lap-belt seat restraints in the population.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We studied both in vivo and in vitro specific host defense mechanisms in patients suffering from chronic post-traumatic osteomyelitis (n— 26). The cell-mediated immunity in vivo was impaired as indicated by the reduced reactivity in the delayed type hypersensitivity skin test. The concanavalin A or phytohemagglutinin-induced T-cell proliferation in vitro was markedly decreased in comparison to healthy donors. In contrast, B-cell proliferation stimulated byStaphylococcus aureusCowan I was not altered. While the absolute lymphocyte counts and the percentage of T, B, and 0 cells were within the normal range, nine out of the 26 patients showed a significantly diminished ratio of CD4+ and CD8+ T cells. Humoral immunity in the patients was less affected as assessed by the unchanged serum levels of immunoglobulins (Ig). However, the T-cell dependent polyclonal Ig synthesis after in vitro stimulation with pokeweed mitogen was suppressed. Our results provide evidence that cell-mediated immune functions are predominantly impaired in patients with post-traumatic osteomyelitis which may contribute to the persistence of the localized bone infection.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The aim of this study was to identify factors associated with Multiple Organ Failure (MOF), and assess possible interactions between the risk factors identified as such. We studied 40 MOF cases and 120 controls, out of all the surgery and trauma patients who needed intensive care at our institution in a 24-month period. The univariate analyses showed that age, hypovolemic shock, massive volume administration (MVA), sepsis, and time of evolution before arriving to the hospital (TE) were significantly associated with MOF. Logistic regression analysis showed that neither age nor MVA were independently associated with MOF after adjusting for all of the other variables. Interactions seemed to be present between age, sepsis, and shock.We conclude that in our surgery and trauma ICU adult patient population, hypovolemic shock, sepsis, and TE are independent risk factors for MOF. The importance of the association between shock and sepsis is discussed, as well as the possible relevance of TE as a risk factor.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Twenty patients with generalized sepsis were studied prospectively to evaluate the effects of recombinant human growth hormone (rhGH) administration. Five patients had developed sepsis after major abdominal surgery, 15 patients after multiple trauma with head injury (HTI-ISS 38 ± 2 and Glasgow Coma Scale 4 ± 1). The urea production rate (UPR) could be significantly reduced by the intramuscular administration of 1.5 IU of rhGH/ kg body weight (BW) per day (UPR day: 5, 62 ± 6.7 gm/d vs. UPR day: 10, 42.6 ± 5.9 gm/d). The catabolic index of Bistrian (BI) was significantly lower after rhGH therapy on day 10 compared to day 5. IGF-1 increased significantly after the administration of rhGH. The nitrogen balance, however, did not become positive, despite the administration of rhGH. The changes in sepsis were estimated by the scoring system according to Elebute and Stoner on days 3, 5, 7, 10, and 13. In those patients who were available for post-treatment evaluation the parameters had returned to baseline values after the withdrawal of rhGH. Results indicate that this therapy might ameliorate the nitrogen intake, but has no influence on the course of sepsis. Compared to previously published results in nonseptic patients, the somatomedin inhibitors as well as the split-products of the complement system and the metabolites of arachidonic acid may have been responsible for this weak effect of rhGH and IGF-1 in septicemia.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Severe trauma favors the susceptibility of patients to infection. It has been shown that proteins or protein fragments are responsible for an endogenous immunodepression. After trauma a coagulopathy accompanied by increased serum levels of fibrinogen degradation products (FDP) is often found. Therefore, we examined whether FDP-D can influence the activity of polymorphonuclear neutrophils (PMN).PMN-activation was measured by two different superoxide-specific methods (Cytochrome-C-test, INT-test). With both methods we found a decrease of PMN activity by FDP-D compared to fibrinogen. Albumin, which was used as a control protein, only influenced PMN activity in unphysiologically high concentrations. The third method used to quantify PMN activity was chemiluminascence, which is a more unspecific method since it is developed not only by oxygen radical species but also by activating the lipoxygenase pathway. In contrast to the superoxide specific tests we found an inhibitory effect of fibrinogen and also serum compared to FDP-D using chemiluminescence.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We designed a model to evaluate the effectiveness of various noninvasive methods of ventilation. The upper airway was simulated with the head of a Resusci-Annie which was attached to a test lung. The esophagus and stomach were simulated with a Penrose drain connected to a rolling seal spirometer via a PEEP valve. Fifteen paramedic volunteers ventilated the model utilizing mouth-to-mouth, mouth-to-mask, bag-valve-mask, or portable field ventilator (Impact or HARV). Recording of tidal volume, gastric volume, and proximal and distal airway pressure was completed at three different levels of compliance.At normal compliance, all methods except the HARV met or exceeded American Heart Association standards. As compliance decreased, tidal volume fell and gastric insufflation increased. At a compliance of 0.02 L/cm H2O all methods failed to meet AHA standards and gastric insufflation volume equalled delivered tidal volumes for mouth-to-mouth and mouth-to-mask techniques. Mouth-to-mouth and mouth-to-mask techniques generated the largest tidal volumes but also created the largest volume of gastric insufflation. The Impact ventilator provided an acceptable tidal volume with minimal gastric insufflation. Our results suggest that mouth-to-mask ventilation with supplemental oxygen enrichment is the most efficient technique for noninvasive airway management.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Among 440 adult patients with tibial shaft fracture and accompanying fibular fracture there were eight cases with radiographically ununited fibulae 4 months after the injury, each with uneventful tibial union. Fractures with severe soft-tissue injuries were excluded from this study. In 293 patients the treatment method of the tibial fracture was conservative, comprising closed reduction and immobilization by long plaster cast. In 147 patients it was intramedullary Kuntscher nailing, and all the eight cases with delayed fibular union occurred among these, the frequency being 5.4%. The typical accompanying fibular fracture to develop delayed union was a comminuted one in the middle or distal third of the bone.At a followup examination 5 to 8 years after the original injury four of the eight fractures were found to have ultimately spontaneously united, while three showed a radiographically indisputable nonunion. One patient had undergone segmental fibular osteotomy because of persistent local pain but in the remaining patients the subjective symptoms were negligible. The occurrence of delayed fibular union in association with rigid intramedullary nailing of concomitant tibial shaft fracture is a phenomenon of which trauma surgeons should be aware even if the natural course of the condition often seems to be benign.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Increased fuel economy and reduced injuries have been portrayed as incompatible goals, based on the false assumption that vehicle weight is the determining factor in both. Physics predicts that size and velocity, not weight, are the primary factors affecting crash forces, while increased weight or increased velocity consumes more fuel. Analysis of fatal injury rates, injury costs, and fuel use in relation to vehicle weight, vehicle size, and engine horsepower confirms that weight is of minimal importance in injury severity compared to the other two factors. Fuel use is a function of weight and horsepower. Injuries and fuel use can be reduced by reducing vehicle horsepower without changing vehicle size.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID