摘要:

At prior meetings of this Association and other societies, I have always looked forward to the presidential address. Seldom have I been disappointed. There is always something that can be learned from the address. I have usually marveled at the knowledge of the speaker and the toil, many times lifelong, exerted in preparation of the text. In addition, among the usually unexciting array of presented scientific papers many of which then proceed to rest forever undisturbed in the bowels of our great medical libraries, the presidential address always has the potential of being a breath of fresh air. At great risk of destroying these images and of greater risk of fulfilling Roger Bacon's fourth postulate of causes of human error of ignorance (17), “the concealment of ignorance in the display of apparent wisdom,” I humbly submit to you my edition of the American Burn Association Presidential Address.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Degloving injuries of the extremities and torso occur with relative frequency and are associated with a high morbidity and mortality. The common aim of all surgical approaches is to reestablish skin coverage over the injured area, but therapies differ in both technique and results. This survey evaluates the management and results of 21 patients sustaining degloving injury of at least % the circumference of the torso or an extremity. Initial surgical techniques which employ application of the skin as a full- or split-thickness graft were contrasted with those in which salvage of the entire flap with its subcutaneous tissue was attempted.The results suggest that immediate use of the degloved skin as a full-or split-thickness skin graft gives the most satisfactory coverage to the denuded areas. Other important features in management include frequent observation and immobilization of the extremity postoperatively, and use of mesh grafts when necessary to cover large areas. Recent emphasis on the blood supply of the skin underscores the importance of its circulation as the determinant of flap survival. Daily observation until the flap becomes fixed is mandatory. Primary reattachment of the full- or split-thickness flap by suture or use of compression dressings without grafting is unsuccessful and should be abandoned as an acceptable approach to this problem.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Renewed interest in conservative nonoperative management of splenic trauma in children led us to review our experience with this injury in 258 patients over the past 5 1/2 years. Blunt trauma was the predominant type of injury, occurring in 241 patients: 80% of these patients had associated extra-abdominal injuries, predominantly involving the head, chest, and extremities; 59% of patients with penetrating trauma had concomitant extra-abdominal injuries, mainly of the thorax. Serious concomitant intra-abdominal injuries requiring operative therapy were found in 36.5 and 94%, respectively, of patients sustaining splenic injury from blunt and penetrating trauma. Children under the age of 16 years exhibited a similar incidence (32.6 and 100%, respectively). Renal, hepatic, diaphragmatic, intestinal, mesenteric, and vascular injuries were most frequent.The pitfall of conservative nonoperative management lies in missing these concomitant serious intra-abdominal injuries. Diagnostic peritoneal lavage is most useful in defining the patients who should undergo exploratory laparotomy, therefore reducing morbidity and mortality secondary to neglected injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Records of 123 consecutive patients who underwent abdominal angiography for blunt trauma were reviewed. Twenty-four patients underwent abdominal angiography on the basis of positive physical findings. Seven (29%) required intervention as determined by angiography and the diagnosis was confirmed. Ninety-nine patients had abdominal angiography in association with angiographic evaluation of the chest, pelvis, head, or extremities. In 14 (14%) the angiogram indicated the need for intervention. In 13 this diagnosis was confirmed at laparotomy. The fourteenth patient was embolized angiographically and did well. Fifty-four patients had peritoneal lavage in addition to their angiograms. Sixteen were positive and 38 were negative. In four patients the lavage was negative and the angiographic findings indicated need for intervention. Three of these four were confirmed at laparotomy and the fourth patient was embolized angiographically.Indications for abdominal angiography in blunt trauma are: 1) incidental to needed thoracic aortography; 2) incidental to angiography when done for pelvic fractures; and 3) suspected intra-abdominal injuries when clinical and lavage data are not definitive.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Injuries to the ulnar collateral ligament of the thumb metacarpophalangeal joint are common and have received considerable recent attention in the literature. Against this increased diagnostic awareness stand surgical repair results, which lack objective criteria. Most authors confine their results to good, bad, or indifferent. We are presenting a followup series of acute primary repairs (under 2 weeks) and late reconstructive repairs.All followup intervals were longer than 6 months (mean, 23 months). Fifteen patients had primary repair: 23 patients had late reconstruction. The age range of the patients was 14 to 62 years (mean, 28 years). Forty per cent of the primary repairs involved a fragment of bone. The two most common types of reconstruction, that using a free tendon graft and that of adductor advancement, are similarly compared. Results were evaluated using range of motion, pinch strength, and radiographs as well as standard subjective criteria, and compared to the normal contralateral thumb. Primary repair achieved 92% of normal pinch strength and 84% of normal thumb motion. Both reconstructive techniques yielded adequate pinch strengths although the adductor advancement (85%) was somewhat greater than the free tendon graft (81%). Range of motion was significantly more restricted in the adductor group (65%) than in the free graft group (78%). Subjectively 15% of patients complained of aching with use of the thumb and 8% complained of weakness and 2% of residual instability. Eleven per cent of the patients with the free graft complained of the increased bulk over the reconstructed area of their thumb. Complications included one rerupture of a primary repair at 10 weeks requiring reconstruction, one failure of an adductor advancement secondary to pullout at 4 weeks during a cast change, one patient with dyesthesias in the dorsal sensory nerve of the thumb that resolved, and one patient with hypertrophic scarring at a palmaris longus graft site.It is clear that primary repair done in the first 2 weeks stabilizes the ulnar side of the metacarpophalangeal joint of the thumb and more closely approaches the function of its contralateral thumb metacarpophalangeal joint. Both reconstructive techniques have their own specific advantages, and both gave adequate functional results. Pinch strength from both tendon graft and adductor advancement were similar but motion was better with the graft. Patients with vocations requiring maximum thumb function, such as in a professional baseball pitcher, may benefit from a combination of the above reconstructive procedures, and these are presented.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The purpose of this study was to determine the most critical substrate or metabolic parameters from among a large number of plasma substances which would predict patient survival or demise in the trauma-septic state. Twenty-five septic patients (14 survivors, 11 nonsurvivors) with 102 analyses were evaluated. Levels of amino acids were analyzed on a pattern basis by use of fractional concentrations (Z values), the ratio of the individual amino acid concentration to the total concentration of either the essential or nonessential amino acids according to the amino acid type. Patients who did not survive (in contrast to survivors) had significantly lower Z values for Ser, Glu, Gly, Val, He, Leu, and Arg, and higher Z values for Asp, Thr, Asn, Pro, Ala, Met, Phe, His, and Trp, all of which indicated marked pattern distortions between the two patient sets. Concentrations of plasma substances reduced in patients who did not survive were taurine, alpha- 1-acid glycoprotein, and ceruloplasmin, and increased were alpha-aminobutyrate, urea, glucose, free fatty acids, triglycerides, lactate, retinol-binding protein, cortisol, and glucagon. Using the same patient data base discriminant analyses, a further form of pattern evaluation, were conducted between the patient groups. With these analyses, patients who later succumbed could be identified 9 days before demise with 99% certainty from a single plasma analysis profile. The variables with greatest discriminant power, in decreasing order, were urea, lactate, the sum of the nonessential amino acids (negative), alpha-aminobutyrate, glucagon, glucose, Z glutamine, Z aspartate, Z asparagine, ornithine (negative), AO2, alpha-1-acid glycoprotein, Z valine (negative), ceruloplasmin (negative), alpha-2-HS glycoprotein, pyruvate (negative), and Z phenylalamine. Alterations in metabolism as reflected in plasma substrate patterns are thus critical indicators of a degrading septic state.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The policy of theJournalhas been to ask at least two members of our editorial consulting board to review all submitted manuscripts. Although both reviewers of the following paper are respected authorities in the area of hemorrhagic shock, there were considerable differences between them regarding this manuscript. Rather than submit the manuscript to additional reviewers, the Editors have elected to publish the reviewers' comments and have invited the authors to reply. The reader is urged to examine these comments and the authors' reply both of which follow the manuscript. (Eds.)Anesthetized rats were submitted to a standardized hemorrhage to 40 mm Hg by withdrawing 35 to 40% of the total blood volume. The plasma water and the extracellular fluid volumes of the whole animal and selected tissues were estimated with 126I human serum albumin and 51Cr EDTA, respectively, after recovery periods of 10 and 90 minutes. The plasma water volume of the whole animal decreased, but approximately 50% of the shed plasma water was restored within 10 minutes after the hemorrhage. The extracellular fluid volume of the whole animal did not change significantly after hemorrhage, whereas this fluid compartment was regionally reduced in the liver, spleen, and subcutaneous fat after a 10-min recovery period but only in the liver after a 90-min recovery period.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

In animals oleic acid induces a form of lung injury similar to that observed following fat embolization in humans. In the present study, canine lower left lung lobes were isolated, ventilated, and perfused at constant pressure with heparinized, autologous blood. Weight gain, in the absence of vascular volume change, in this preparation is a sensitive indicator of edema. One group of lobes was pretreated with 5.1 mg/gm lobe wt methylprednisolone before 1 μl/kg body wt oleic acid. An untreated group given only oleic acid served as controls. Following oleic acid, the reduction in effective lobe compliance and blood PO2and the increase in perfusate total protein concentration were similar in both groups. Rate of lobe weight gain following oleic acid was remarkably linear in both groups but significantly lower (p< 0.05) in lobes pretreated with methylprednisolone. The latter group showed a total weight gain of 21% compared to 34% in the controls 3 hr after oleic acid challenge. We conclude that oleic acid induces a pulmonary edema in the absence of an elevation in hydrostatic pressure. Furthermore, rate of edema formation is attenuated by methylprednisolone pretreatment.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Between January 1978 and March 1979, we conducted a prospective and retrospective study of 202 consecutive blunt trauma patients ages 11 to 92 years. All patients admitted through the trauma service to the intensive care units at LDS Hospital (Salt Lake City) from a low population density area were scored using the Injury Severity Score (ISS) and Glasgow Coma Score (GCS) and patients were categorized according to outcome. There were 30 deaths, for a mortality rate of 14.8%. Twenty-six patients had persistent morbidity, 12.9%. The mean ISS for death was 39; for morbidity, 36; and for patients who were successfully rehabilitated, 23. There were 119 patients with head injuries. The mean GCS was 7 for nonsurvivors, 10 for patients with morbidity, and 12 for rehabilitated patients. We conclude that commitment is a major factor in determining the effectiveness of any trauma system. We strongly encourage regionalization of trauma care and education of paramedics, emergency medical technicians, and physicians in the rapid triage of high-risk patients to a major trauma center.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

This report demonstrates prolonged effective release of silver sulfadiazine (AgSD) to experimental burns in rats from a solid dressing formed by mixtures of polyethylene glycol-400 and poly-2-hydroxyethyl methacrylate. The synthetic dressing, incorporating the antimicrobial drug, may be formed either directly on the burn wound or prepared as a preformed sheet and applied to the wound after it was contaminated with bacteria. The level of silver in the blood following treatment of the burn wound with topical AgSD (Silvadene, Marion Labs) is significantly less when the drug is presented in the dressing than when the drug is applied in a cream base; the concentration of the sulfadiazine moiety in the blood is similar for the two drug preparations. Improved survival of the burned and contaminated rats and reduced nursing care were observed in the burned animals when the synthetic dressing was used to deliver the drug relative to the results when the AgSD was applied in a cream base by standard procedures.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID