摘要:

Septic shock was induced in adult baboons by the infusion of liveEscherichia coli. A progressive derangement in skeletal muscle cell function was documented by the direct measurement of declining transmembrane potential difference (PD). A concurrent depolarization of the red blood cell (RBC) was characterized by cellular uptake of chloride, sodium, and water, and loss of potassium. The decrease in RBC PD was significantly greater than the change predicted to occur from acidosis alone. These findings are compatible with changes in membrane permeability and decreased active transport. The continuous accumulation of RBC adenosine triphosphate during shock suggests decreased energy utilization rather than decreased energy production as a factor leading to diminished active ion transport.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

To determine limitations in survival and problems of single and multiple organ failure (SOF, MOF) following trauma in Bavaria, we reviewed 433 consecutive patients with multiple injuries treated at the Klinikum Grosshadern from 1978 through 1982. Most patients were young and were injured in traffic accidents. The overall mortality was 18% (78 deaths): 38 deaths were due to CNS injuries (49%), six from miscellaneous causes (7%), 15 associated with SOF (19%), and 19 associated with MOF (25%). There were 50 patients with SOF and 34 with MOF. Two MOF patterns were found: a rapid single-phase (15 patients) due to trauma and shock; and a delayed two-phase MOF (19 patients) due to trauma, shock, and sepsis. Mortality for the MOF group was 56%. The lung was the predominant organ to fail represented in all SOF and MOF cases. Cimetidine and pirenzipin prevented stress bleeding in all but four patients. Significant factors leading to MOF were shock, massive blood transfusions, sepsis, and errors in treatment. The temporal sequence of organ failure was lung, clotting system, kidney, and liver. Sepsis was ultimately the cause of death in eight MOF patients (42%). Earlier pulmonary and cardiovascular support beginning at the scene of the accident, and prevention and better treatment of head injury, respiratory failure, and sepsis are critical factors for increasing survival after injury.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Recent studies on cerebral resuscitation following an ischemic anoxic insult suggest that both inadequate reperfusion and direct neuronal death are partially initiated by calcium entry into vascular smooth muscle and neurons. To investigate the effects of calcium blocking agents on cerebral resuscitation, a controlled perfusion arrest model with cardiopulmonary bypass was used. Post-resuscitation regional cerebral cortical blood flow (rCCBF) and intracranial pressures (ICP) were monitored in five control dogs and in 12 study dogs resuscitated after a prolonged (20-minute) cardiac arrest. The resuscitation included dexamethasone and three agents thought to be calcium entry antagonists and to offer potential cerebral protection after complete prolonged cerebral ischemic anoxia.Prearrest rCCBF measured by a thermal dilution method with a thermistor placed on the cerebral cortex was 2.0 ± 0.6 (S.D.) ml/gm/min on bypass at 100 mm Hg mean arterial pressure. Twenty minutes after resuscitation was begun, the rCCBF in ml/min/gm were: controls 1.1 ± 0.3; dexamethasone (2 mg/kg) 1.2 ± 0.4; MgSO4(100 mg/kg) 1.8 ± 0.5; verapamil (0.15 mg/kg) 1.9 ± 0.4; and lidoflazine (1 mg/kg) 1.5 ± 0.3. Ninety minutes following the beginning of resuscitation the rCCBF were: controls 0.1 ± 0.1; dexamethasone 0.1 ± 0.1; MgSO4, 1.7 ± 0.3; verapamil, 1.9 ± 0.4; and lidoflazine, 1.5 ± 0.3 ml/gm/min.Thus the Ca2+entry antagonists maintained cerebral blood flow at 20 and 90 minutes following a prolonged ischemic anoxic insult. Dexamethasone was no better than control. These data suggest that calcium entry blockers can maintain rCCBF and may have a significant role in cerebral resuscitation following cardiac arrest.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Acute renal failure (ARF) was induced in two groups of unilaterally nephrectomized dogs by occluding the renal artery, vein, and ureter of the remaining kidney for 2 hours. The control group (Group I), had no therapy; in the experimental group (Group II), isovolemic hemodilution was carried out using 6% hydroxy ethyl starch (HES) as diluent. The hematocrit in the experimental animals was lowered from 41.62 ± 3.6% to 23.75 ± 5.2% after renal occlusion. The mean arterial pressure and the mean pulmonary arterial pressure were unchanged in either group. Cardiac output increased following hemodilution from 1.66 ± 0.35 to 2.70 ± 0.50 L/min while it remained unchanged in Group I. Control animals developed ARF characterized by progressive rise in serum creatinine concentration and death. Only 1/7 Group I animals was alive on day 7 compared to 7/7 of Group II (p< 0.01). ARF that developed initially in Group II began to resolve after day 4. There was a progressive and significant fall in serum creatinine concentration from 6.48 ± 0.67 mg/dl on day 4 to 4.08 ± 0.83 mg/dl on day 7 (p< 0.001). Immediate isovolemic hemodilution with HES can reverse ARF induced by ischemia.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The healing rate of small experimental burns continuously treated topically with 96% O2and 75% relative humidity was followed for 25 days. Serial image photographic magnifications (tenfold throughout) of the wounds enabled precise measurements of their size by means of a polar planimeter. Healing rate was expressed as decreased percentile of wound size on a given day compared to the initial area. The mean percentages of healing ± SEM of the humidified O2treated wounds on postburn days 6, 11, and 16 were 31.25 ± 6.15, 82.09 ± 3.52, and 98.29 ± 1.46, respectively, and those for the control wounds were 7.08 ± 2.20, 47.68 ± 3.39, and 84.41 ± 1.38, respectively. Analysis of variance revealed highly significant differences in the healing rate between O2-humidity-treated and control wounds (p< 0.005). The results indicate that topical treatment with 96% O2and 75% relative humidity improved healing of experimental burns in guinea pigs.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The remarkable progress achieved in control of infections in burned patients has significantly increased survival rates. Nevertheless, septic complications are still the leading cause of death in these patients. The immunologic disturbances present after severe burns certainly play a key role in susceptibility to infection, and in particular the impairments of the phagocytie system warrant major investigative efforts in order to increase host defenses. Determination of phagocytic and microbicidal capacity of neutrophils from burned patients evidenced a marked functional impairment of these cells. The alterations recorded were partly due to intrinsic (cellular) defects, and partly to extrinsic (serum) defects. Indeed, opsonic factors are known to be reduced in these patients, but also phagocytosis-inhibiting factors such as immunocomplexes have been detected in the patients we have studied. Administration of the immunomodulating agents methysoprinol and timostimoline were found to be effective in partially restoring netrophil function. Rational immunotherapy in burned patients will consist of replacement of humoral mediators, clearance of inhibitory factors and stimulation of the cellular effectors of immunity.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

There is, at present, little literature to guide one in the management of a patient with a gunshot wound to the chest with normal vital signs, physical examination, and as a normal chest X-ray. The present study followed up 357 patients as outpatients at 48 hours, then 1 and 3 months. No major complications developed. Minor complications included chronic wound pain, chronic wound swelling, and the uncomfortable sensation of being able to palpate one's own subcutaneous bullet. The wound infection rate was only 1.5% with or without antibiotics, showing that prophylactic antibiotics are probably not warranted if good surgical wound care is practised. We conclude that patients with gunshot wounds to the chest with normal vital signs, physical examinations, and normal X-rays can be reasonably treated as outpatients after 4 hours of observation, at the physician's discretion.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Hepatic dysfunction following injury is felt to be due to hepatic ischemia. To test this hypothesis we measured hepatic blood flow (HBF) and splanchnic oxygen delivery and consumption in nine multiply injured patients. HBF, measured by indocyanine green clearance, was 0.4 ± 0.1 L/min/m212 hours after injury. It steadily increased to 1.3 ± 0.1 L/min/m2by 1 week after injury. Changes in cardiac output were similar and were due largely to changes in HBF. Hepatic hypoperfusion was correlated with subsequent increases in serum bilirubin. High oxygen consumption was associated with high HBF and oxygen delivery, and splanchnic oxygen consumption became a large fraction (range, 21–67%) of total body oxygen consumption. Although splanchnic oxygen delivery was diminished with low HBF, splanchnic oxygen consumption remained normal (37 ± 2 ml/min/m2) due to increased oxygen extraction. We conclude that hepatic blood flow is markedly reduced after injury. Reduced HBF is correlated with liver dysfunction although normal splanchnic oxygen consumption is maintained.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The increasing popularity of skiing as a recreational sport has resulted in a greater number of major thoracic and abdominal injuries. These injuries, unlike the more common orthopedic injuries, are often life threatening. This 8-year study reviews 44 thoracic and abdominal ski injuries managed at an urban trauma center since the inception of a helicopter air evacuation program with in-flight resuscitation capabilities. Twenty-five per cent of the injured had signs of hemorrhagic shock, and nearly 60% required a major operation. The injuries were caused by high-speed collisions with stationary objects or other skiers and by falls. Three were penetrating injuries. Organs injured were: heart, lung, kidney, spleen, liver, rectum and abdominal wall, and more than half were multiple injuries. Almost half had associated orthopedic trauma. Resuscitation was initiated on helicopter arrival in these seriously injured patients (78% of helicopter-transported patients came to operation), and apparently contributed to the low mortality of 4.5%.

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