ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We describe four cases of ocular trauma incurred while playing women's lacrosse without eye protection. Women's lacrosse is potentially hazardous because, unlike men's lacrosse, helmets and face masks are not required. These ocular injuries could have been prevented with the use of protective eyewear.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Burn injury causes acute thrombosis and occlusion of vessels in the dermis directly killed by thermal energy. A vascular response also occurs in the uninjured dermis bordering the site of injury. Diminished blood flow leads to progressive ischemia and necrosis in the dermis beneath and surrounding the burn. If blood flow is maintained or restored in this area, the tissue survives. A noninvasive technique for studying dynamic changes in blood flow in this transitional dermis in rats is presented. A rectangular brass bar 19 mm wide with 5-mm transverse notches was heated in boiling water and applied to the skin surface for 20 seconds, making a “comb” burn composed of a row of four rectangular 10 x 19-mm full-thickness burns. Between the burns were 5 x 19-mm bands of uninjured skin, called “interspaces.” After burning, blood flow near the surface of both the burn sites and the interspaces was monitored with a laser Doppler perfusion monitor for 24 hours. The vascular patency of blood vessels was directly visualized by latex vascular casts made 24 hours after burn. The possible prevention of progressive ischemia by injecting systemic ibuprofen was examined in this new model. Normal skin has a surface blood flow reading of 80 ± 16 mV, burn sites have a reading of 11 ± 4 mV, and interspaces have a reading of 21 ± 4 mV at 24 hours postburn in untreated rats. Systemic ibuprofen given IM immediately postburn at 12.5 mg/kg increased blood flow to 80 ± 28 mV within the interspaces, to 17 ± 12 mV in the burn site, and to 80 ± 9 mV in normal skin. The vascular casts showed an absence of patent vessels within both the burn sites and interspaces in untreated rats. The four individual burn sites had generated into a larger single full-thickness injury. In treated rats patent vessels were present in the interspaces but not in the burn sites. Four individual wounds were evident at 24 hours. Histologic preparations of vascular casts showed the absence of latex-filled vessels and thrombus-filled vessels in the burn sites and the interspaces of untreated rats. With ibuprofen therapy, latex-filled vessels were evident within the interspaces and dermis as were thrombus-filled vessels within the burn sites.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

This study measured the adrenergic receptor response of 13 patients with severe intra-abdominal sepsis, who required laparotomy and an open abdominal closure with Marlex mesh. The source of the sepsis was gram-negative organisms of intestinal origin. There were seven survivors and six nonsurvivors. When the patients were stratified into survivors and nonsurvivors, the Septic Severity Score, the APACHE II score, the Acute Physiological Score, and the Glasgow Coma Scale score results were not significantly different between groups. The alpha-2 and beta-1 adrenergic receptor responses were measured in the adipose tissue of the abdominal wall and the small bowel mesentery on day 1 of admission to the intensive care unit. The results demonstrated that the alpha-2 and beta-1 receptors of the nonsurvivors had a significantly decreased receptor response with desensitization and down regulation. The alpha-2 and beta-1 receptors of the survivors had an increased response with hypersensitization and up regulation. This study indicates that the adrenergic receptor pattern is distinctly different between survivors and nonsurvivors with severe abdominal gram-negative sepsis. The pattern differences occurred early (within 24 hours) when the patients had similar physiologic profiles. It is concluded that adrenergic receptor response may be a biologic indicator of the magnitude of the septic injury and a predictor of outcome.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Evidence from studies of trauma patients suggests that selective decontamination of the digestive tract (SDD) might also be of value in preventing colonization and infection by enteric organisms in burn patients. In a retrospective study, 31 consecutive patients with burns of >30% of total body surface area, admitted over a 2-year period, who were treated with an SDD regimen, were compared with a similar group of 33 consecutive patients admitted in the 2 years immediately preceding the introduction of SDD. Fewer SDD-treated patients developed wound colonization withPseudomonasspecies (29% vs. 61%), or with Enterobacteriaceae (10% vs. 73%). Similar reductions in colonization with gram-negative organisms were found in urine and gastric aspirates. There were fewer respiratory infections in the SDD group (6.5% vs. 27.3%), and only one patient developed septicemia, compared with eight in the control group (3.2% vs. 24.2%). Fewer SDD-treated patients died (one death, compared with seven in the non-SDD group). These results suggest that SDD may be of value in the management of patients with severe burn injuries, but further studies are required to test the validity of this conclusion.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We compared the survival of 658 seriously injured patients treated in Los Angeles County in the Fall of 1982 (prior to the activation of the trauma system) with that of 766 such patients treated in the Fall of 1984 (when the system was young and composed of essentially a full complement of trauma centers). We demonstrated a statistically significant improvement in the adjusted odds of survival for 1984 over 1982 with regard to victims of motor vehicle collisions who sustained multiple serious injuries (1980 Injury Severity Score: 26–50) (p= 0.042). For the data set as a whole, although an improvement in survivorship over this period was suggested by the data, statistical significance could not be demonstrated.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Thirty-five patients with sequential fractures of both hips were studied prospectively. The second hip fractures occurred more commonly if the patients were institutionalized, if they suffered from concomitant neurologic diseases such as previous stroke or Parkinsonism, or if there was biochemical evidence of osteomalacia. Twelve patients sustained the contralateral hip fracture within 12 months of the first one. There was a significant correlation between biochemical evidence of osteomalacia and early occurrence of the second hip fracture. Although rehabilitation was difficult for such patients, it was possible with a longer period of intensive physiotherapy; only three patients were not able to walk upon discharge from the hospital after the second hip fracture.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Eighty patients with traumatic rupture of the thoracic aorta were treated. Seven patients died during the initial resuscitation. Forty-three patients underwent surgical repair using the clamp-and-sew technique; 14 patients had a heparin-bonded shunt placed, and 16 patients were repaired using cardiopulmonary bypass. An interposition Dacron graft was used in only 19 patients (26%). The last 32 consecutive patients underwent primary repair of the ruptured aorta. Overall mortality was 19.2% (14 of 80); 9 of 14 patients (64%) had laparotomies along with the aortic repair, and 13 of 14 patients (92%) had three or more associated major injuries. Paraplegia occurred in four cases (5.6%). Traumatic aortic rupture remains a difficult surgical problem. Primary repair, without graft interposition, is the preferred technique and can be accomplished even when the two aortic ends have retracted several centimeters.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We determined the relationship between oxygen delivery, Do2, and oxygen consumption, Vo2, in sheep after a moderate smoke inhalation injury and 15% TBSA third-degree burn compared with burn alone and controls. Comparison was made beginning three hours after injury when carboxyhemoglobin levels were back to baseline values. We decreased Do2between three and eight hours by 25% by either removing blood (controls) or decreasing the resuscitation fluid infusion rate. Lung oxidant, measured as tissue malondialdehyde (MDA) levels, and histologic changes were also assessed. Animals were killed at 24 hours. We found that in controls and animals with a burn alone, a 25% decrease in Do2was compensated for by an increase in O2extraction, maintaining Vo2constant. Correlation of Do2to Vo2wasr2= 0.3, indicating independence of Vo2from Do2. With the combined injury, Vo2decreased in proportion to Do2, since O2extraction did not increase. The correlation of Do2to Vo2wasr2= 0.9, indicating delivery-dependent consumption, a pathologic process most likely caused by increased inflammatory mediators from the combined injury. Lung lipid peroxidation was markedly increased in the combined injury, 148 ± 18 nmol MDA/gram of tissue compared with burn alone, 64 ± 5 nmol/g, or controls, 45 ± 4 nmol/g. However, no decrease in arterial O2tension or increase in lung water was noted, i.e., the sheep did not have ARDS, which is known to impair O2extraction. We conclude that a pathologic O2delivery-dependent consumption develops with the combination of burn and inhalation injury, increasing the potential for tissue hypoxemia. This change corresponds with increased lung tissue oxidant change.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID