摘要:

The publication ofInjury in Americaemphasized a renewed interest in the scientific study of trauma. Collection and analysis of population-based data were viewed as necessary prerequisites for the establishment and evaluation of injury prevention programs. While it was noted that there is an existing broad-based gathering of injury mortality information, it was also made clear that there is a paucity of systematically collected morbidity data. A fundamental step toward correcting this deficiency is to identify and adopt a uniform system for coding causes of injury morbidity that is compatible with the large body of mortality data currently being collected. This paper describes a microcomputer-based program, which is intended to aid in the selection of External Cause of Injury Codes (E-codes). It is designed for coding both fatal and nonfatal injury causes and is appropriate for use in the hospital setting. The system is a modification of the one currently used for coding all injury deaths in the United States.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

With consideration to the relatively high complication rate of internal fixation methods in the management of open fractures, 16–36% (17), the use of 'fixateur externe' or Hoffmann's apparatus is widely accepted as the best method of management. We do not have this valuable apparatus in our hospital due to the socioeconomic constraints typical of developing countries. We found a valuable improvisation in the use of Bohler's transfixation methods and even to the extent of achieving osteotaxis and ambulation. The management method is described with our positive experiences of its use in 28 cases of open fractures and other bone and joint afflictions. The advantages and disadvantages of the method are discussed. The method is recommended as a valuable substitute for the 'fixateur externe.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

A retrospective study (1972–1983) was made of 622 consecutive patients who suffered renal trauma, in order to assess the incidence and prevalence of post-traumatic renal hypertension. In 435 (76%) of the 569 survivors long-term followup data and blood pressure recordings were obtained, 13 months to 12 years after trauma (mean, 5.6 years). Renal trauma could not be linked to an increased incidence of hypertension: on first control, only 94 patients (21%) demonstrated a casual elevated blood pressure (> 140/90 mm Hg). The presence of a fixed hypertension was validated in only 14 patients. Twelve of them were extensively screened in the Department of Internal Medicine. In none of these patients could a definite relationship between hypertension and renal trauma be documented.Furthermore, an extensive review was done of 223 cases of post-traumatic renal hypertension reported in the literature from 1951 until 1984. Careful analysis of these previously described cases (71 publications) leads us to criticize the widespread accepted cause-effect condition with regard to posttraumatic renal hypertension. It is concluded that adequate management of renal injuries with early diagnosis and individualised surgical treatment can prevent this extremely rare complication.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Acute response after traumatic events was studied in serial serum samples of 21 patients over a period of 13 days. Among the various biochemical and hematologic parameters, serum amyloid A (SAA) exhibited the most striking changes, with a pattern similar to that of the tissue marker creatine-P kinase (CPK). Maximal SAA level was detected 3–4 days after onset of the event, and reached 216 ± 41 SEM gm/ml (normal range <2 gm/ml), while maximal CPK level was detected on the same day and reached 530 ± 242 SEM IU/L (normal range 24–195 IU/L). Fibrinogen, leucocytes, platelets, albumin, alkaline phosphatase (AP), and calcium (Ca) each showed its own typical pattern of change. Fever did not develop.Comparison of SAA levels after various acute events suggests that damage to the myocardium is the most powerful stimulus for SAA induction, followed by traumatic events, arthritis, viral infections, and malignant diseases.It seems therefore that although acute response is considered a generalized reaction, it is not completely independent of the localized events which induce it. Among the known parameters, SAA is the most sensitive marker for monitoring the intensity of events.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Investigation of the antibody response toStaphylococcus aureusinfection has been hindered by lack of a simple and specific assay. We report an enzyme-linked immunosorbent assay (ELISA) using a strain of S.aureusdevoid of Protein A, a frequent cause of false positive results in ELISAs, and have used this assay to study antibody responses of 23 severely injured patients. This IgM ELISA had a diagnostic sensitivity for major Staphylococcal infection of 70% (seven of ten patients with major infection) and a specificity of 92% (12 of 13 patients without major infection). Of three patients with major Staphylococcal infections who mounted no IgM response, two died and the other developed severe chronic Staphylococcal infection, and hence prompt initiation of appropriate therapy was necessary. Furthermore, the ability to mount IgM response to Staphylococcal infections appears to contribute to an orchestrated host defense response against this organism.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The effect of small volume hypertonic saline in “uncontrolled” hemorrhagic shock (UCHS) induced by partial resection of the tail was studied in rats. The rats were divided into three groups: in group 1(n= 15) 10% of the terminal portion of the animal's tail was resected to induce UCHS. In group 2(n= 14) UCHS was induced as in group 1 and after 5 min 5 ml/kg NaCl 0.9% (NS) was infused intravenously. In group 3 (n = 22) UCHS was induced as in group 1 and after 5 min, 5 ml/kg NaCl 7.5% (HTS) was infused intravenously. Resection of the animal's tail was followed by bleeding of 3.5 ± 0.3 ml within 5 min, fall in MAP to 63 ± 4 torr (p< 0.001) and pulse to 300 ± 18 per min (p< 0.05). The amount of bleeding, fall in MAP, and pulse after 5 min were similar in the three groups. Further blood loss after 60 min in group 1 was 3.7 ± 0.8 ml, in group 2, 2.9 ± 0.5 ml, and in group 3, 6.5 ± 0.8 (p< 0.01). Increased bleeding in group 3 showed two peaks: an early peak of 1.3 ± 0.2 ml after 15 min (p< 0.05) and a late peak of 1.2 ± 0.4 ml at 45 min (p< 0.05) and 1.7 ± 0.5 ml at 60 min (p< 0.01). MAP fell after 60 min to 54 ± 7 torr in group 1 (p< 0.01). It increased to 68 ± 7 torr (p< 0.05) in group 2 and decreased to 50 ± 7 torr (p< 0.05) in group 3. Increased bleeding and a fall in MAP following HTS infusion resulted in an early death of 73% of the animals with a mean survival time of 115 ± 11 min. The mortality of the animals in group 1 was 20% and in group 2 12% with a mean survival time of 166 ± 7 and 176 ± 4 min, respectively. The mean survival time in group 3 was significantly lower than in group 1 (p< 0.01) or group 2 (p< 0.01).It is concluded that HTS infusion in “uncontrolled” hemorrhagic shock leads to increased blood loss from injured vessels, fall in MAP, and early mortality.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Advances in prehospital stabilization and resuscitation of traumatized victims continue to have an impact on morbidity and mortality. Certain aspects of Advanced Trauma Life Support still remain controversial. Recent reports have questioned the usefulness of IV's started in the prehospital phase both because of delay in transport and because of the actual or theoretical lack of adequate volume infusion during transport.If IV lines can be started while an accident victim is en route to the hospital with no delay in transport, then much of the argument against prehospital IV's becomes irrelevant.From October 1985 through November 1986 we prospectively studied IV access attempts in 350 consecutive patients. Overall IV's started at the scene were 77% successful (n = 70) and en route 81% (n= 213) of attempts were successful. Of those with BP < 100 mm Hg, there were 66% successful on-scene attempts and 72% successful en-route attempts.Protocols for IV administration in non-trapped patients should initiate IV access only en route to the hospital while the ambulance is moving. Even if delay at the scene is minimal, it is not possible to justify any delay, since IV's can be successfully instituted en route.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Food withdrawal 24 hr before hemorrhage has been shown to increase experimental post-hemorrhage mortality, and survival is associated with the degree of hyperglycemia. Lack of hyperglycemic response has been attributed to depleted glycogen reserves after 24-hr food withdrawal. To investigate the effect of short-term food deprivation on glucose metabolism during hemorrhagic stress, glucose production (rate of appearance, Rd), glucose uptake (rate of disappearance, Rd), glucose clearance, and glucose recycling were investigated in fed and 24-hr food-deprived rats under basal conditions, and during hemorrhagic hypotension using 3-H3-U-C14-glucose. During hemorrhage, blood glucose levels were higher in fed rats. Hemorrhage induced a decrease in glucose clearance irrespective of nutritional state in both 24-hr starved animals and rats in the postprandial state. Calculated glucose recycling increased in both groups after hemorrhage. The results indicate that hemorrhagic stress induces a rapid increase in gluconeogenesis, as reflected by increased glucose recycling.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

This is a retrospective study of 124 patients with carotid injuries. The common carotid artery was injured in 84% of the patients. Associated trauma to the internal jugular vein was present in 26%. Most patients (56%) were dead on arrival to the hospital and of those who were operated on, the mortality was 22% (overall mortality, 66%). All operative mortalities had severe shock or neurologic deficits on admission. We performed repair on all patients with preoperative neurologic deficits and the mortality was 64%. The use of a shunt did not influence the prognosis. We believe that there is no place for an emergency angiogram in order to diagnose a carotid injury or to plan the operation.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Twenty-five patients with aseptic nonunion of the humeral shaft, treated by a combined therapeutic procedure, are reported. The initial treatment of these 21 closed and four open fractures had been nonoperative in 21 patients and surgical in four. Seven further open procedures had been performed in four of these patients, also undergoing failure. The time period between the fracture and our treatment averaged 13 months (range, 6–46 months). A uniform therapeutic protocol, consisting of decortication, internal fixation with a broad, straight DCP ASIF plate and autologous cancellous bone grafting, was performed in all cases, supplemented with the use of surgical cement in one. Radiologic healing was achieved primarily in 24 patients in periods averaging 6 months and after renewal of the protocol in one patient. Followup averaged 35 months (range, 8–69 months): results were good in 21 patients.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID