ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Since 1974 we have performed muscle flap transposition (myoplasty) for the treatment of a skin loss of the lower leg with associated exposure of the bone. In order that the operative treatment may be completed in one stage, mesh skin graft was done simultaneously with muscle transfer. Twelve cases so far have been treated successfully by this procedure, the mesh skin graft taking well on the muscle flap.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

The incidence of serious ocular injuries found in association with periorbital fractures, 10%, was determined through a retrospective review of 230 patient records. Eye injury was most frequently in conjunction with supraorbital fractures. A brief survey of the diagnosis and treatment of the injuries identified, loss of visual acuity, global laceration or rupture, retinal contusion, intraocular hemorrhage, glaucoma, and optic nerve damage, is presented, with special emphasis on the importance of the acute physical examination of the eye and determination of visual acuity. Use of the recently developed method of diagnosing glaucoma and determining visual acuity, the Arden Sine Wave Grating, is discussed.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

To evaluate the morbidity and mortality attending emergency resection of the right colon, we studied retrospectively 119 consecutive patients from two major centers, particularly examining the role of delayed anastomosis (initial ileostomy with subsequent ileocolic anastomosis). Emergency right colectomy was defined as an operative procedure in which partial resection of the terminal ileum and total or partial resection of the cecum and/or ascending colon were necessary before the colon could be evacuated and prepared as might be the case in elective resection. Ninety patients underwent primary anastomosis; hospital mortality and morbidity were 26 and 11%, respectively. Among 29 patients who underwent ileostomy, hospital mortality was 38%; hospital morbidity was 10%. In general, the patients selected for ileostomy were somewhat more ill or had more severe injury. Only 17% of all deaths and 8% of all serious complications could be attributed to the anastomosis, leaving little statistical opportunity for improvement by deleting it. The data indicate that a very high mortality (29%) attends emergency right hemicolectomy. Our study indicates that ileostomy in lieu of anastomosis does not reduce this high mortality.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Autopsies of 1,105 burned patients completed from January 1951 through March 1977 were reviewed at the United States Army Institute of Surgical Research to investigate the relationship between central venous and pulmonary artery cannula use and the incidence of endocarditis. The incidence of endocarditis increased from 3.4 to 9.4% after 1969 when cardiac injury attributed to central venous cannula use was first noticed at autopsy. Since 1969, right heart nonbacterial and bacterial endocarditis has dramatically increased and the right heart has become the prevalent site of the cardiac lesions. Review of premortem chest roentgenograms from 14 recent autopsy cases with right heart endocardial injury confirmed that central venous catheter tips were placed in the vicinity of the right atrium or right ventricle in 86% of the cases. Pathogenetically, the majority of the infected right heart lesions are probably the result of cannula-induced injury, with subsequent thrombosis and later bacterial colonization during episodes of bacteremia which are common in burned patients.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

We have observed, by light and electron microscopy, fibroblast-like cells which appear to be involved in collagen fiber and filament degradation. These cells are most prominent in the dermis of mature hypertrophic scars which were clinically observed to be in the remodeling phase of wound repair. Total incorporation of collagen filaments within cellular vacuoles, as seen by TEM, appears to precede the enzymatic degradation of the collagen. Cytoplasmic contractile bundles and/or collagen filament remnants found within residual lysosomes were also seen in many of these cells. Evidence of structural reorganization within the tissue was observed by means of SEM. These cells appear to be similar to osteoclasts in function: thus we propose to name them “fibroclasts” and “myofibroclasts.”

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

The fine structure of the microvasculature was compared among eight samples of normal skin, 79 granulation tissues, 48 hypertrophic scars, 11 hypertrophic scars treated with mechanical pressure, and 13 mature scars. Increased synthesis activity is suggested in endothelial cells from granulation tissues, is less in hypertrophic scars, and low in mature scars. In hypertrophic scars most of the microvessels appear partially or completely occluded. Endothelial cell nuclei are crenated, many villous projections from the endothelial cell membranes exist on the blood side, and endothelial cell junctions are often complex, although no large gaps are observed. In all the granulation tissues studied fibrin polymer is present, occurring intraluminally and interstitially, which may be related to endothelial cell proliferation.Therapeutic mechanical pressure over 1 to 3 months effects striking changes in endothelial and perivascular satellite cells. Rented areas appear in endothelial cell cytoplasm. A few such areas were found in cases of nontreated hypertrophie scars but in no other group. Pressure-treated scars also demonstrate degenerating perivascular satellite cells, which also are observed in a few cases of mature scars but in no other group.A previously published theory that hypoxia is related to generation of the hypertrophic scar, and that pressure probably increases hypoxia, resulting in long-term focal degeneration of selective cells, appears further supported by the present findings.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

During a 15-year period, 18 patients with major burns developed a wound infection due toAspergillus. Ages averaged 28 years; extents of burn were 54% (14–97%) BSA for total surface involvement and 42% (14–85%) BSA for full-thickness injury.Pseudomonassepsis precededAspergillusinfection in 16 cases. Thirteen of the episodes occurred in three epidemics, each apparently related to contaminated air-conditioner ducts and filters. Treatment was based upon wound excision in all 18 patients, with recurrence initially in each. Topical and parenteral antifungal agents were never individually successful in controlling the infection. Whenever fungal sepsis involved an extremity alone and thus amputation could rid the body of the entire infected site, survival could then be achieved. The overall mortality rate was 78%. Protection of the wound fromAspergilluscolonization appeared to be the only reliable method of preventing this often lethal fungus infection.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Post-mortem radiographs as well as careful inspection at autopsy of 100 consecutive traffic accident victims revealed an incidence of cervical spine injury of 24%. All but four of the 24 fractures and/or dislocations were localized to the level between the occiput and the axis. One half of the cases were not clinically suspected of having spine injuries before the detailed postmortem search. Seventeen of the 24 cervical spines were resected en bloc and the pathologic anatomy of the injuries was determined. The high incidence of cervical spine injuries and the anatomic findings at dissection have clinical implications for physicians who manage multiply traumatized patients. The need for immobilization and early radiographic evaluation of patients with cervical spine injuries is emphasized.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

In order to quantitatively investigate the usefulness of intraosseous fluid and drug administration as a resuscitative modality, we studied the infusion flow rates of crystalloid solutions obtainable at varying infusion pressures into the bovine tibial medullary cavity and time to initial as well as 90% of maximal effect of intraosseously administered vasoactive drugs. Mean infusion rates ± SEM (n= 6) at 300, 200, and 100 torr and atmosphere + 81 cm H2O were 41 ± 2, 32 ± 1, 27 ± 2, and 10 ± 1 ml/min, respectively. The mean time (± SEM) to initial effect of intraosseous injections (n= 6) of either 0.5 mg epinephrine or 50 mg ephedrine was 17 ± 3 seconds and mean time to 90% of maximal effect was 45 ± 5 seconds. These results provide a quantitative basis for resuscitation by fluid and drug administration via the tibial malleolar intraosseous route and suggest that when performed in appropriate situations, the technique may have clinical utility.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID