摘要:

Previous reports have failed to demonstrate a statistically significant adverse effect of acute ethanol intoxication in the well-resuscitated trauma patient. In the present study the prevalence of acute alcohol intoxication and its effect on outcome was analyzed in a homogenous population of young, previously healthy motorcycle accident victims (N= 134). The incidence of intoxication was 25%. The intoxicated cyclists were at fault for the accident 50% more often than the nonintoxicated cyclists and were found to wear helmets one third as frequently. Furthermore, the protective effect of helmet use as seen in the nonintoxicated group was lost in the intoxicated group, who sustained head injuries twice as frequently. Only patients with critical head injuries died and, although the ISS levels of those dying were similar in the two groups, the mortality following the critical head injury was twice as high among intoxicated patients (80 vs. 43%). Overall, the intoxicated group had a fourfold increased mortality rate. Thus, although intoxicated motorcyclists comprised 25% of the total population, they represent a mere 9% of the helmet-wearing population, and, in contrast, 39% of the severely head-injured victims and a majority (57%) of the mortality rate.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The present study was performed to determine whether insulin resistance, independent of the prevailing hormonal milieu, occurs in the liver during sepsis. To determine this, sepsis was produced in rats by cecal ligation and puncture (CLP). Six hours later, when the rats were in the early hypermetabolic phase of sepsis, the livers were isolated and perfused with Krebs-HCO3buffer using a nonrecirculating system. The effects of various concentrations of insulin on the gluconeogenic response to lactate and phenylephrine stimulation were determined. In the absence of insulin and phenylephrine, there was no difference in the rates of glucose production from lactate between septic and sham-operated rats. The gluconeogenic response to phenylephrine stimulation was, however, significantly depressed in the livers from septic rats. Addition of 50 μU insulin/ml resulted in an inhibition of the phenylephrine-stimulated glucose release from livers from sham-operated rats. This inhibition was maximal at 100 μU insulin/ml. In contrast, significant inhibition of phenylephrine-stimulated glucose release from livers from septic rats was only observed in the presence of 2,000 μU insulin/ml. These results demonstrate that even during the early, hypermetabolic phase of sepsis, depressed hormonally stimulated hepatic gluconeogenic capability occurs. In addition, livers from septic rats exhibited a resistance to the effects of insulin on gluconeogenesis. This resistance may account, at least in part, for accelerated gluconeogenesis in spite of hyperinsulinemia in early sepsis.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Standard burns were sequentially produced on the backs of Sprague-Dawley rats at 0, 1, 2, and 2 1/2 hr, followed by the IV injection of Evans blue dye. All animals were killed at 3 hr, and burns evaluated by wet/dry weight ratios, and Evans blue extravasation scored 1–4 by two observers. Five groups of rats were compared to controls. Rats made neutropenic by exposure to137cesium showed no significant difference in wet/dry weight ratio or Evans blue extravasation compared to controls. At 1 1/2 hr four other groups were treated with various inhibitors of arachidonic acid metabolism including ibuprofen, a cyclo-oxygenase inhibitor; FPL 55712, a leukotriene (LT) receptor antagonist; ketoconazole, an inhibitor of thromboxane (Tx) synthetase; and lodoxamide, a calcium channel inhibitor. All treated groups showed significant reduction of Evans blue dye extravasation. Wet/dry weight ratios were significantly reduced in rats treated with FPL 55712 and ketoconazole before or after burning. These data support the postulate that oxygenation products of arachidonic acid, particularly Tx and LT, are important mediators in early burn edema.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Wound contraction, a process whereby wound edges are drawn together, is thought to be mediated by the myofibroblast cell population. However, experimental wounds may close as much as 25% (surface area) before the onset of fibroplasia which is marked by the migration of fibroblasts and myofibroblasts into the wound bed 2 to 3 days after injury. This early phase of wound closure appears to be mediated by a contractile force produced by a circumferentially arranged band of fusiform-shaped epidermal cells situated in the wound margin. Cytoplasmic microfilaments in the epidermal cells, similar in size and configuration to actin filaments and/or tonofilaments, are found to be aligned with the long axis of the constitutive cells comprising the contractile band. The data suggest that contraction in experimental wounds is promoted by at least two distinct cell-mediated contractile events: an initial although brief phase effected by cells of the epidermis followed by an extended phase of soft connective tissue contraction produced vis à vis the myofibroblasts in the dermis.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

To investigate the pathophysiology and treatment of right ventricular (RV) contusion we assessed biventricular function via volume expansion in eight open-chest, anesthetized, ventilated dogs. Measurements were obtained before and after RV contusion with a captive bolt pistol and during dobutamine infusion. RV contusion depressed both RV and left ventricular (LV) performance as assessed by classical ventricular function curves (p< 0.05). Dobutamine reduced filling pressure (p< 0.05) and increased cardiac output (CO) (p< 0.01) when infused post contusion. Because, on inspection, the LV was not contused, the apparent depression in LV function is most likely due to reduced diastolic compliance secondary to ventricular interdependence. In support of this possibility, in four dogs, LV performance significantly improved (p< 0.05) when the pericardium was opened. We conclude that RV contusion can depress the relationship between CO and filling pressures in both ventricles and that dobutamine is superior to volume in treating the resultant low cardiac output state.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Administration of naloxone, an opiate antagonist, is known to improve survival from hemorrhagic shock and to reverse the effects of septicemia on gastric mucosal O2tension and potential difference (PD). We tested these potentially cytoprotective actions in the ex-vivo canine gastric chamber model with acid, bile, and hemorrhagic hypotension. Naloxone (2 mg/kg IV bolus, then 2 mg/kg/hr IV) was given before or during shock. Naloxone did not affect oxygen consumption, the bile-induced drop in PD, or the transmucosal movements of H+, Na+, K+, and fluid. The reduction in average mucosal lesion formation with naloxone pretreatment (5.4 ± 1.2 vs. 2.8 ± 0.5%) was not statistically significant (p= 0.07). Similarly, administration of naloxone after the onset of shock also failed to protect the mucosa from stress ulceration. We conclude: 1) naloxone does not inhibit the effects of topical bile on the gastric mucosal barrier; 2) naloxone has no apparent effect on local gastric vascular resistance during hemorrhagic shock; and 3) the therapeutic potential of naloxone as an anti-ulcer drug is questionable.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Trauma of the bladder from external force is associated with severe multiple injuries and the resulting mortality rate is substantial. The major associated injury was fracture of the pelvic bones which was present in 346 (83%) of the 417 patients with bladder trauma. Contusion of the bladder was present in 280 (67%), intraperitoneal rupture in 53 (13%), extraperitoneal rupture in 76 (18%), and both intra- and extraperitoneal rupture in eight (2%). Radiologic evaluation of the bladder by a retrograde cystogram using 400 ml of dye is recommended to diagnose the type of bladder injury. Nonoperative (catheter) management of extraperitoneal rupture of the bladder was used in 18 patients and resulted in complications in four of the 18.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Eighty-two infra-isthmal fractures of the femur were reviewed in order to develop a fracture classification, to determine the results of treatment, and to define the best treatment methods for certain specific fracture patterns. Type I (transverse or short oblique) fractures were seen in 36 patients (mean age, 33 years). They had a 25% complication rate when treated by open reduction, and a high malunion rate when treated by closed means. Type II (spiral or long oblique) fractures were generally caused by falls, and were seen in 36 patients (mean age, 56 years). Most patients treated by operation had an unsatisfactory result. Malunion was seen in 29% of the patients treated by closed means. The remaining ten patients had either severely comminuted (Type III), or pathological (Type IV) fractures.Intramedullary nail fixation should be used wherever possible in these fractures since many of the complications in the operative group were related to rigid plate fixation. Closed treatment resulted in an unacceptably high incidence of malunion in this study, particularly in Type I fractures. Conventional methods of internal fixation were not successful in dealing with Type II fracture, and alternative methods are proposed.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Between 1976–1979, 87 Type III open fractures (in 75 patients) were treated at the Hennepin County Medical Center. Factors leading to increased morbidity in Type III fractures were: massive soft-tissue damage; compromised vascularity; severe wound contamination; and marked fracture instability. This study demonstrates, because of varied severity and prognosis, that the current designation of Type III open fracture is too inclusive. We recommend, therefore, that Type III open fractures be divided, in order of worsening prognosis, into three subtypes.Type IIIA—Adequate soft-tissue coverage of a fractured bone despite extensive soft-tissue laceration or flaps, or high-energy trauma irrespective of the size of the wound.Type IIIB—Extensive soft-tissue injury loss with periosteal stripping and bone exposure. This is usually associated with massive contamination.Type IIIC—Open fracture associated with arterial injury requiring repair.Wound sepsis in the three subtypes were: Type IIIA, 4%, IIIB, 52%; and IIIC, 42%; while amputation rates were, respectively, 0%, 16%, and 42%. Only two patients developed osteomyelitis, and 12 patients had delayed or nonunions. Five patients died, all as a result of multisystem trauma.The bacterial pathogens in infected open fractures have changed dramatically over the years. In the present series (1976–1979), 77% of infections were due to Gram-negative bacteria, compared with 24% previously (1961–1975). A change of antibiotic therapy from a first-generation cephalosporin alone to a combination of a cephalosporin and an aminoglycoside, or a third-generation cephalosporin, is currently indicated in Type III open fractures.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Intracarpal canal interstitial fluid pressures were determined in the wrists of 22 patients with 23 Colles' fractures. Mean values were 18 mm Hg in neutral wrist position, 27 mm Hg in 20° flexion, 47 mm Hg in 40° flexion, and 35 mm Hg in 20° extension. Ten of 23 wrists (45%) had pressures greater than 40 mm Hg in 40° of flexion. Because of the high incidence of median neuropathy associated with immobilization of wrist fractures in a position of marked flexion, an awareness of the magnitude of increased interstitial fluid pressure should lead to alternative methods of treatment in many cases.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID