摘要:

The high morbidity after severe thermal insult is believed to be related partially to a resultant decrease in immunocompetence. We tested the ability of phytohemagglutinin (PHA) and Concanavalin (Con A) to stimulate lymphocyte transformation in 17 patients with moderate to severe thermal injury (>25% BSA). The patients acted as their own controls and the per cent change in their mitogen response was measured over time. Eight acutely burned patients who subsequently developed severe sepsis (Group I) had decreased ability (mean, 12% of normal) to proliferate in response to PHA, and six of these died of severe sepsis. The depressed response appeared 4 to 7 days postinjury and predated clinical evidence of sepsis by 2 to 4 days. Cells from four patients who had mild infectious complications (Group II) demonstrated greatly augmented mitogen responses (mean + 243%) approximately 7 to 10 days postinjury. Five burn patients whose clinical course was sepsis free (Group III) exhibited only minimal changes in their mitogen responses (mean +30%). Although the Con A responses of the patients' cells corresponded less to their pathology, Group I patients whose cells exhibited depressed PHA responsiveness also had diminished Con A responses. Group II patients' cells also showed increases in Con A-induced stimulation. Group HI patients, who had only slightly augmented PHA responses, had minimal decreases of the Con A-induced lymphocyte transformation. Many severely burned patients develop septicemia as a result of their large wound surfaces. The appearance of decreases in mitogen-induced proliferation, however, appears to characterize those patients who will be unable to handle the septic challenge.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Lipolysis was studied by measuring glycerol turnover (GTO) in injured and infected patients. GTO was elevated two to three times the normal values in five injured and four infected patients during D5W infusion. No correlation was found between GTO and plasma glycerol concentration in the two patient groups. GTO showed similar levels when measured during TPN in five injured and three infected patients. During TPN, plasma FFA levels remained unchanged in injured but decreased by 48% in septic patients. B-OH butyrate concentrations were high during D5W and dropped in both groups during TPN. Norepinephrine urinary output was high in both groups during D5W and TPN.Conclusions: 1) GTO was elevated two to three times the normal range in injury and infection; plasma glycerol concentration was not related to GTO. 2) In face of high catecholamine output, the insulin response to TPN did not inhibit TG breakdown but did decrease plasma ketone body concentrations.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Three hundred twenty-seven bite injuries of the hand were reviewed for incidence of infectious complications. A policy to hospitalize all patients with human bite injuries was maintained, but noncompliance was high. Patients with uninfected or superficially infected bites (131) were hospitalized and treated with parenteral penicillin, cephalosporins, or clindamycin (mean duration, 45 hours). Among the 62 patients not lost to followup three minor septic complications occurred. Of similar patients not hospitalized (134), only two thirds received antibiotic therapy but no complications were observed. These data suggest that human bite hand infections can be averted and that established superficial infections can be successfully treated with outpatient antibiotic therapy.Of the 62 patients with moderately to severely infected human bites, 77% were injured by striking an opponent; 52% suffered injury over metacarpophalangeal joints. The mean delay in seeking medical attention was 2% days, compared to day in the less severely infected group. Of the patients with more seriously infected bites, 94% received parenteral antibiotic therapy. Of 30 patients with known outcome in the latter group 27% suffered complications (stiffness; recurrent infection; other infectious complication), confirming the high morbidity of established deep hand infections secondary to human bites.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Abdominal stab wounds are managed on a selective basis with increasing frequency. Retroperitoneal injuries are more difficult to evaluate; hence wounds to the flank and back pose different considerations. A retrospective review of 108 patients with deep stab wounds of the flank and back was compared with a prospective study of 109 patients selectively managed with similar injuries. Physical examination was accurate in 86% of flank and 88% of back wounds. Local exploration was an effective procedure in differentiating superficial from deep wounds. Peritoneal lavage may be more accurate in flank wounds but is probably less reliable with retroperitoneal injuries. Adjunctive studies are helpful in selected patients. The incidence of negative celiotomies was reduced from 85.2% to 7.3% when the selective approach was adopted. There was no mortality or increased morbidity in the series. Although the risk of retroperitoneal injury is greater with flank and back wounds, frequent examination by the same observer combined with adjunctive studies in selected cases appears to be a safe, reliable method of managing patients with stab wounds of the back and flank.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Records of 373 patients with penetrating wounds of the lung seen at the Ben Taub General Hospital over a 1-year period were reviewed. Intercostal tube thoracostomy was the only therapy required in 282 patients. Thoracotomy was performed in 91 patients with repair of a pulmonary lesion in only 45 patients. Pneumonorrhaphy was performed in 33 patients, segmentectomy in six, and lobectomy in two. Four patients required repair of tracheal injuries. Fourteen patients initially treated with intercostal tube drainage required thoracotomy for complications of clotted hemothorax in eight and empyema in six. There were 29 deaths. Penetrating lung trauma in the majority of patients may be treated conservatively with a low incidence of infection or complication. Of the patients who require thoracotomy, associated injuries will frequently represent the major operative indication. Early thoracotomy for complication of clotted hemothorax or empyema is encouraged.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Fifty patients, with 71 hands affected by deep dermal burns, underwent tangential excision and immediate autografting at a mean of the fifth postburn day. Assessment of the group at 6 weeks showed an 8% mortality, good hand function in 50%, fair function in 18%, and poor function in 24%. The total group was partitioned into patients with burns of 40% or less and those with burns of greater than 40% of body surface. The former group had significantly better hand function than the latter. Early tangential excision with immediate autografting of deep dermal hand bums is recommended for almost all patients with small to moderate thermal cutaneous injury. However, only after careful evaluation should patients with large, life-threatening thermal injuries be selected for this procedure.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

A review of the past literature of gunshot wounds indicates that the clinical material deals mainly with high-velocity missile injuries from military experience. A series of 66 cases of low-velocity gunshot wounds to the maxillofacial complex at San Francisco General Hospital between 1971 and 1978 indicates a clinical difference between injuries caused by low-velocity as compared to previously reported high-velocity missiles. Damage to vital structures resulting from missile injury to the maxillofacial complex are classified in three anatomic areas: 1) supra-orbital (28 cases of which 20 involved neurological damage); 2) mid-face (24 cases of which 8 involved the orbits and/or globe); 3) lower face (14 cases, of which 3 involved laceration of the carotid and 2 involved airway obstruction necessitating tracheostomy).The management of gunshot wounds to the maxillofacial area is outlined, emphasizing: 1) Debridement and prompt closure of intraoral wounds with antibiotic coverage: 2) Early stabilization of mandible fractures: 3) Indications for tracheostomy; 4) Arteriographic studies. In our series there were only four infections, which were treated easily with incision and drainage and appropriate antibiotic selection.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

The mechanical cornpicker causes tearing and crushing hand injuries. Fifty-one patients treated at Mayo Clinic for these injuries from 1962 to 1975 were studied with regard to mechanism and extent of injury, treatment methods, and long-term results. Some amputation occurred at the time of injury in 36% of hands, and in 73% of the remainder following treatment. Initial treatment in nearly all cases consisted of debridement, tetanus prophylaxis, and antibiotics, and 73% of hands required some form of delayed surgical treatment.Antibiotics did not appear to be helpful. Eighty-nine per cent of injuries occurred in October and November. Carelessness was the most common cause given by farmers for their injuries. Excluding four permanently disabled patients, the average length of disability was 135 days. Eighty-nine per cent of patients experienced some permanent impairment of hand function. The mechanical cornpicker is described, and the importance of its proper use and physician's emphasis on accident prevention as well as treatment are stressed.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Failure of microvascular re-perfusion, no reflow, of the brain after a period of ischemia has been proposed as the etiology of the cerebral dysfunction frequently seen in patients after resuscitation from hemorrhagic shock. For this investigation rats were stressed by subjecting them to a period of combined hypoxia and hypotension followed by resuscitation. Micro-oxygen electrodes measured brain oxygen tension, thus allowing an assessment of the distribution of cerebral blood flow, during stress and after resuscitation. After resuscitation, a hyperemic response was noted, followed by gradual return of some areas of the brain to normal perfusion, while other areas remained hyperemic for at least 2 hours post-resuscitation. On the basis of these results there appears to be no support for the no-reflow hypothesis. These data imply that therapeutic modalities aimed at increasing cerebral blood flow and oxygenation in the post-resuscitation period are insufficient in themselves for improved survival of patients sustaining a hypotensive, hypoxic episode.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Chondritis may develop as a secondary complication of trauma to the ear. Its onset is often insidious and may be delayed until after apparent healing has occurred. Treatment is difficult, but if postponed, the result may be complete destruction of the external ear. A method of aggressive surgical therapy combined with antibiotics is presented which, when utilized early, results in good healing with minimal residual otic deformity.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID