摘要:

A nonautopsy, retrospective analysis of severe motor-vehicle accident trauma can provide valuable information in regard to volume of trauma and quality of care. In a 6-county region surrounding a large metropolitan area trauma care, as reviewed by this method, had deficiencies at all levels of delivery. Patients were taken to the nearest hospital. Hospitals then had not been classified or designated according to capability. Twenty=-five per cent of the fatalities and 16% of all outcomes were considered inappropriate for the severity of injury incurred. A regional trauma system with categorization and designation of hospitals providing trauma care would have eliminated or improved these deficiencies, resulting in improved outcomes for a significant percentage of these patients.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

To examine the role of early excision and grafting in the preservation of maximal function of hands with deep dermal burns, we prospectively evaluated 164 burned hands in consecutively admitted patients (mean age, 29 years; mean burn size, 37% of body surface). All hands with burn depths of second degree, deep second degree, or third degree above the level of the tendons and joint capsules were assessed preoperatively, intraoperatively, and at discharge from the hospital. Patients were treated by excision and grafting in the first or second postburn week, by delayed grafting alone, or by allowing primary healing. Total active range of motion measurements were made on the day of discharge (mean, 64th postoperative day). Mean operative blood loss per hand was 1,270 ml. When all (alive and dead) patients undergoing early excision and grafting were examined by a binomial probability model, early surgery was shown to produce no adverse affect on survival. Excision and grafting of hands with deep dermal burns, whether early or late, offered no advantage over physical therapy and primary healing in maintaining hand function. Likewise, hands with more superficial burns responded equally to operative and nonoperative treatment. While early excision and grafting of hands with third-degree burns tended to produce poorer results than did initial nonoperative care and late grafting, the differences are just outside the range of significance. Early excision and grafting of selected third-degree injuries of the hands may be indicated in patients with small total body surface burns in order to shorten hospital stay. However, early surgical intervention in patients with massive burns should be directed toward area coverage, not toward hand excision.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

After finding changes in the biochemical response to injury in patients who had consumed ethanol (27) we have examined the effect of acute ethanol intoxication on the outcome of injury using the bilateral hindlimb ischemia model in the rat. Technical difficulties were encountered but it was possible to devise an experiment in which realistic plasma ethanol levels and a lowered redox state were present during the response to a standard 4-hr period of bilateral hind-limb ischemia. Acute intoxication had little effect on the mortality rate or survival time. Extrapolating the findings to man it would seem that if ethanol intoxication increased the dangers associated with trauma its effect would be in increased risks of airway obstruction due to vomit, etc., rather than in altered biochemical responses.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Because of previously reported hepatic abnormalities in burns, the activity of the hepatic drug metabolizing system was assessed in burned Sprague-Dawley rats. In 16% burned male rats, pentobarbital sleeping times were significantly prolonged from day 1 to day 24 ostburn, and trichloroethanol sleeping times were significantly prolonged from day 1 to day 10 postburn. The activity of p-nitroanisole O-demethylase was significantly depressed in male rats at 5, 10, and 17 days post-16% burn. In female rats, this enzyme was more depressed at 10 days post-16% burn than in male rats. A direct relationship was found between per cent burn and impairment of enzyme activity. The depression of drug metabolizing enzymes was inducible by phenobarbital pretreatment. Pretreatment with the immunosuppressive drug azathioprine prevented the enzyme depression at 5 days postburn, a result which possibley implicates a postburn hyperimmune response as the mechanism for the depressed enzyme levels.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A commercially available human IgG chemically modified for intravenous infusion (IGIV) was tested in burned mice for activity against eight strains ofPseudomonas aeruginosa.An 8.7 to 9.6% full-thickness burn was made with a gas flame on the shaved backs of anesthetized mice. A suspension ofP. aeruginosain 0.5 ml saline was then injected subcutaneously in the burn site. Inocula included seven American Type Culture Collection reference strains representing the seven Fisher-Devlin-Gnabasik immunotypes plus an additional strain of immunotype 1.IGIV immunotherapy did not significantly reduce mortality in burned mice challenged with immunotypes 5 and 6 but was highly protective against immunotypes 1–4 and 7. Groups of mice challenged with these five types and treated with approximately 100 or 400 mg IGIV/kg body weight had cumulative mortality rates at 15 days ranging from 0 to 30%, versus an overall mean 84.3% mortality in human serum-albumin treated controls. IGIV was protective if given up to 12 hours after challenge. These data indicate that IGIV has significant in vivo activity againstP. aeruginosaand suggest that IGIV immunotherapy may be of value in the treatment of major thermal trauma in man.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Critical analysis of 53 cases of Malgaigne fracture of the pelvis was undertaken at Hennepin County Medical Center, Minneapolis, over a 10-year period (1968–1978) with particular emphasis to immediate and late complications. Thirty patients were followed from 2 to 12 years after injury. Eleven patients were asymptomatic. Eleven had paresthesias of the lower extremity on the same side as the fracture. Nine had gait disturbance, eight had severe low back ain, four had groin pain, and two had fecal incontinence. Low back pain as a late sequela was related to sacral or sacroiliac injury. There appeared to be a correlation between the amount of displacement of the detached hemipelvis and the frequency of subsequent low back pain. Reduction of the upward displacement of the hemipelvis, by whatever means, to anatomic configuration can be of help in reducing late sequelae. In the later years of this study external fixation was successful.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Fractures of the first rib are uncommon. Bilateral fractures of the first rib are still rarer. A case of bilateral fracture of the first rib due to indirect trauma is reported because of its rarity. Pain at the base of the neck was the presenting symptom in our case and analgesia was the only treatment.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID