摘要:

The natural history of electrical injury, exclusive of electrical flash burns, was determined in 64 patients. These patients sustained relatively small burns (x = 11%); only nine patients (14%) had burns greater than 25%. Forty-six patients suffered 114 major complications. EKG abnormalities occurred in 36%, including major cardiac arrhythmias in ten patients. One-fourth of the patients developed neurologic sequelae (CNS–8, peripheral–8). Electrical vascular injury with subsequent arterial occlusion was responsible for many of the major amputations. Nineteen patients required 32 amputations (digits–17, hand–1, foot–2, leg–3, arm–9).Early patient referral and vigorous fluid resuscitation minimized renal failure (1.5%) and mortality (3.1%). Early fasciotomy and vigorous debridement appeared to decrease wound sepsis (8%), but apparently had little if any effect on major limb salvage. The unsolved problems of electrical injury, namely neurological and vascular sequelae, are major contributors to the high morbidity of electrical injury.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

The treatment of penetrating thoracic injuries has been reviewed in both civilian and military series. Although most surgeons agree that closed thoracostomy drainage is the initial treatment of choice, the timing of early thoracotomy and perhaps cardiorrhaphy upon patients with penetrating thoracic injuries remains controversial. The purpose of this study was to determine which patients will require immediate thoracotomy or cardiorrhaphy following penetrating chest injury.Over a two-year period 190 patients with penetrating thoracic injuries were treated. Of 53 patients who required immediate thoracotomy, 31 suffered cardiac wounds. Seventy-nine patients required laparotomy for associated intra-abdominal injuries. The mortality rate was related to exsanguinating hemorrhage or postoperative intra-abdominal sepsis. Cardiopulmonary complications were rare in the absence of intra-abdominal sepsis and could not be attributed to the thoracic injury or thoracotomy. Indications for immediate cardiorrhaphy or thoracotomy are: 1) location of the entrance wound (70% in upper mediastinum); 2) blood pressure on admission <90; 3) initial thoracostomy blood loss >800 cc; 4) radiographic evidence of retained hemothorax; and/or 5) clinical evidence of pericardial tamponade.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

The major problems requiring solution before full-scale evaluation of stroma-free hemoglobin solution (SFHS) in a clinical environment are its high oxygen affinity and relatively short intravascular retention time. Through postmanufacture chemical modification of SFHS we have been able to improve both properties as determined in in vitro and in vivo studies. Permatization of SFHS with pyridoxal 5'-phosphate (PLP) does not affect oxygen-carrying capacity and improves the P50and intravascular retention. This chemically modified hemoglobin is worthy of further evaluation.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

During the past 2 years, Citrate-Phosphate-Dextrose (CPD) blood preservative solution has largely replaced Acid-Citrate-Dextrose (ACD) solution in most blood banks, partly because of the superior preservation of diphosphoglycerate levels (2,3 DPG) and oxygen transport of red cells stored in CPD solution. Although superiorin vitromaintenance of oxygen transport capabilities is established, fewin vivocomparative studies have been done.Forty-four trauma patients were studied who had 90% or more of their estimated blood volume replaced acutely: 24 patients received blood preserved in ACD solution; 20 received blood preserved in CPD solution. Samples were obtained immediately after transfusion and then daily. Values of P50and 2,3 DPG were adjusted for covariance on mean age of transfused blood.The relationship between P50and 2,3 DPG was significant acutely and at 24 hours in ACD-transfused patients (r=0.91,p<0.01;r=0.856,p<.01). The relationship between P50and 2,3 DPG was not significant acutely, but was at 24 hours in CPD-transfused patients (r=0.67,p<0.10;r=0.74,p<0.01). Comparison between patients transfused with ACD and CPD by P50, 2,3 DPG, and length of storage was not significant.When massive transfusion of blood products is required, the ability of blood banks to provide transfusion components will determine the shelf-life, and therefore the oxygen transport capability, of the blood administered. Whether resuscitation with blood of advanced shelf-life is deleterious could not be determined from this retrospective study. Although no practical superiority of CPD over ACD could be demonstrated,in vitrostudies clearly demonstrate CPD to be superior to ACD solution in maintenance of 2,3 DPG values. The present study is not intended to justify continuance of ACD as a preservative. It suggests that the small preservative advantage of CPD over ACD will probably eventually result in the development of a solution superior to ACD and CPD.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

“It could be recorded in history that outstanding contributions based on experience of managing Vietnam casualties by American military surgeons did as much to stimulate and direct interest and success in repair of venous injuries as was established during the Korean Conflict with repair of arterial injuries.”

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

An elementary technique for discontinuously measuring intracranial pressure, ventricular chemistry, cellularity, and topography, employing percutaneous needle tapping of an implanted module consisting of a Rickham reservoir-ventricular catheter for the chronic monitoring of severe head injury patients is presented. The intracranial pathophysiological conditions (increased ICP, persistent CSF cellularity, xanthochromia and elevated protein levels, and hydrocephalus) occurring in seven so instrumented patients recovering from such injuries are reviewed. The simplicity, safety, and multidiagnostic capability of the system are emphasized.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

The clinical management of 47 patients with vascular injuries of the extremities is presented with emphasis on functional results. The method of restoration of vascular continuity or the presence of associated fractures or venous injury had little bearing on either the success of arterial repair or functional result. The most significant factor adversely affecting restoration of extremity function was the presence of associated major proximal nerve injury.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

We report two cases of myonecrosis occurring as a complication of carbon monoxide (CO) poisoning and comment on its frequency, probable causes, and treatment. A 20-year-old man was admitted comatose due to CO poisoning and developed massive, progressive edema of both legs within a few hours. Frank myoglobinuria ensued. Fasciotomy was performed promptly, but return of musculoskeletal function was incomplete. An elderly lady was hospitalized because of diffuse myalgia and weakness, and muscle biopsy showed nonspecific rhabdomyolysis. Renal failure also developed on the day of admission but resolved spontaneously, as did her symptoms. Investigation of her home revealed excessive CO leaking from a faulty stove.We found 13 other cases of myonecrosis associated with CO poisoning in the English-language literature. In some instances, necrosis of the muscles results from progressive edema due either to endothelial damage by CO or to the weight of the body on itself during prolonged coma. Patients with this kind of injury develop compartment syndromes and should have fasciotomy. In other instances, however, the necrosis is more diffuse and seems to be a result of chronic exposure and direct damage to the tissues. Myoglobinuria and renal injury may occur in either group of patients due to severe muscle damage.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Certain injuries to the aorta, vena cava, and long segments of peripheral vessels preclude lateral arteriorrhaphy or primary end-to-end anastomosis. In such cases some type of vascular prosthesis is required. The choice of a suitable vascular prosthesis in potentially contaminated wounds is open to controversy.In the past 5 years, more than 500 patients were seen with vascular injuries at the Ben Taub General Hospital: 122 required prosthetic interpositions to bridge the defect; 57 had Dacron tube grafts; 63 had autogenous saphenous graft interposition. Three had extra-anatomic bypass grafts (Dacron). Among these, 102 wounds were potentially infected, and in 20 there was definite contamination documented at the original operation. Twelve perigraft infections were seen postoperatively, five in patients with Dacron and seven in patients with vein prostheses. Disruption of the entire vein conduit was seen in five patients with vein prostheses resulting in profuse hemorrhage, with two late amputations. Among the five peri-Dacron infections, three had intermittent anastomotic leaking, but no evidence of thrombosis or hemorrhage. There were six early deaths, all secondary to massive blood loss and shock. Two late deaths occurred (at 5 weeks and 12 months).Although the graft infection rate was identical, patients with peri-Dacron graft infections had more easily managed complications than those with infections around an autogenous vein prosthesis. When practical in potentially contaminated traumatic vascular injuries, Dacron appears to be preferable to autogenous vein as a substitute conduit when an extra-anatomic prosthetic routing is not feasible.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID