摘要:

The oxygen delivery capacity of fresh whole blood was compared with that of 21-day-old blood in an isolated, perfused canine hindlimb preparation. At the outset, 21-day-old blood was found to have depressed levels of 2, 3 DPG and higher p50's relative to those of freshly procured blood, implying an increased oxygen affinity of the former product. Despite this, oxygen consumption from 21-day-old blood was not demonstrated to be significantly different than that from fresh blood. It is concluded that significant improvement in oxygen delivery capacity alone should not be construed as justification for the choice of fresh over older blood in clinical replacement therapy.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

The present report is a retrospective review of 23 patients admitted to the University of Kentucky Medical Center during 1975 and 1976, selected because they had sustained renal trauma as ascertained by hematuria, intravenous pyelography (IVP), or operative intervention. The value of IVP was determined by the patients' eventual hospital course. Of five patients with penetrating injuries, all had hematuria and an intravenous pyelogram on admission. One of these patients did not require an operation. Among the 18 patients with blunt abdominal trauma, six of the 14 patients who had hematuria and an IVP on admission were spared operation. Four patients didnothave hematuria, but all four had a renal lesion. Two of these patients required an operation: one for inspection of a traumatic left nephrectomy; the other for bilateral renal artery occlusion, successfully repaired after 16 hours.Whenever feasibleallpatients sustaining abdominal trauma should have an IVP regardless of whether or not hematuria is present.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

It has been widely accepted that peritoneal drainage minimizes postoperative intra-abdominal sepsis following liver injury. In a review of 254 patients with liver injury who survived more than one day (blunt, 67.3%; penetrating, 32.7%), 27 patients had peritoneal drainage, only six patients had perihepatic drainage, and in the remaining 21 patients, the drains were positioned to drain nonhepatic injuries. Postoperative intra-abdominal sepsis occurred in 4.8% of the undrained patients and in 7.4% of the drained patients. In seven of the 11 undrained patients who developed postoperative intra-abdominal sepsis, the sepsis would not have been averted by perihepatic drainage because the septic site would not have been included in perihepatic drainage or because the sepsis related to leakage of a pancreaticoduodenectomy anastomosis. Postoperative intra-abdominal sepsis occurred in only 1% of the patients with nonbursting liver injuries. In contrast, 19.6% of the patients with liver bursts developed postoperative intra-abdominal sepsis. Sepsis following liver bursts was not related to the use of or to the avoidance of peritoneal drainage. Based upon these data we conclude that: peritoneal drainage is not indicated for capsular tears or for minor or major liver lacerations, and that the value of peritoneal drainage in the prevention of intra-abdominal sepsis following bursting liver injuries remains unsubstantiated.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

We have reviewed 546 cases of hepatic trauma treated from 1964 through 1976: 76 patients with blunt injury, 308 with gunshot wounds, and 162 with stab wounds. Hypovolemic shock was present in 22%. The overall mortality was 10%. Stab wounds had a negligible mortality of 0.6%, whereas 12% of patients with gunshots and 28% of patients with blunt trauma died. Management followed the general principles of control of hemorrhage and conservative debridement with avoidance of major procedures. Eighty-four per cent of patients required only drainage or suture and drainage. Only 8% had extensive debridement. An additional 5% (31 patients) underwent hepatic lobectomy. Hepatic artery ligation, as an isolated procedure, was not employed. Common bile duct cannulation was employed only six times. Mortality among patients treated by suture or drainage was 5.4%. When resection was required, a 52% mortality resulted. We conclude that the principles of conservative surgical treatment can give a satisfactory survival rate in most hepatic trauma.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

In a study of 310 burned patients, 27 of whom died, treated during a recent 3-year period, we have found that the following factors contributed to mortality: severity of the burn injury, advanced age of patients, race of the patients, cause of the burns, pre-existing medical problems, inadequate or inappropriate early resuscitative measures, and possible errors or oversights in the management of a few patients. Whether the patients were treated by general or plastic surgeons and whether the patients were “staff” or “private” appeared to have no significant bearing on survival or mortality. Death rates for the sexes were approximately equal.Deaths of patients who survived the immediate postburn period resulted mainly from pulmonary failure, renal failure, sepsis, and cardiac failure or from various combinations of these factors.Presented at the Thirty-seventh Annual Session of The American Association for the Surgery of Trauma, 15–17 September 1977, Detroit, Michigan.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Traumatic injuries of the portal venous circulation occur infrequently but often pose management problems. During the past 13 years, 94 patients have been treated at the Ben Taub General Hospital for traumatic injury to the portal venous system, including 37 portal, 45 superior mesenteric, seven splenic, and nine inferior mesenteric venous injuries. Injury resulted from penetrating wounds in all but 17 patients. Associated vascular injuries were present in 80 patients. Twenty-six patients died from failure to control hemorrhage. Six deaths resulted from postoperative complications. Operative approach necessitated lateral venorrhaphy in 66 patients, ligation in 23, end-to-end anastomosis in one, saphenous vein mesocaval shunt in two, end-to-side portacaval shunt in one, and clamping and packing in five. In spite of numerous associated vascular and visceral injuries, portal venous injuries can be successfully managed utilizing generally available vascular reconstructive techniques.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

High-tension electrical burns sustained by 44 patients were of two types: one is caused by the intense heat of contact with an electric arc, and in the other flow of current against resistance of the deep tissues between arc wounds of entrance and exit produces deep thermal destruction. Microscopic studies in nine patients support the conclusions that such high-tension burns are thermal injuries, that the tissue destruction is not uniform, and that the slow evolution: of unexcised wound reflects the admixture of areas of varying tissue viability which may become infected. An aggressive surgical approach designed to minimize tissue loss, avoid infection, and close wounds as early as possible was guided by intraoperative and later microscopic determinations of tissue viability. Despite a high amputation rate in our patients, it was avoided in the upper extremity in three patients, and maximal length of extremities was preserved in seven others. The use of microscopic analysis is recommended to determine the viability of tissues in thermal burns.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Seventy-seven major thermal injury victims were studied with a number of hematologic and immunologic tests initially and sequentially during the first postburn month. The patients were grouped by initial prognostic index as well as by ultimate survival. Pairs of test data from subjects studied at successive time intervals were compared with prognostic index and ultimate survival. Statistically significant changes in coagulation, fibrinolytic, complement, and kinin tests all occurred within these groups. These findings strongly suggest that intravascular contamination occurs following thermal injury in proportion to the extent of the burn, because of the occurrence and persistence of statistically significant multiple system changes. Regrouping all of the blood data according to ultimate death or survival reinforced the concept of intravascular contamination and provided the basis by which one can compute laboratory prognostic indices. The combination of plasminogen, C'3 complement, C'H50, one-minute kinin, and TEG index discriminated between death and survival with 91% accuracy by the end of the first postburn week. These data offer the potential for select blood measurements in refining current prognostic indicators. This may provide an objective data base for the analysis of new treatment programs in thermal injury victims.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Liver blood flow was measured in the dog under control and hemorrhagic shock conditions by the133Xe clearance method.133Xe was administered first into the portal vein and its clearance from the liver recorded, and then directly into the liver tissue and another clearance curve was obtained. The results were compared. We have also investigated the effects of corticosteroids, given in pharmacologic doses, on liver blood flow in hemorrhagic shock.We have shown that the difference between the results of tissue injection and those of portal injection of133Xe was not significant (p> 0.10). Hemodynamic studies indicated that the liver blood flow is decreased, the liver venous resistance and portal venous pressures are increased in dogs in hemorrhagic shock, and that hydrocortisone, with the blood pressure and the bleedout volume held constant in the experimental model, lowers the liver venous resistance and raises the liver blood flow significantly (p< 0.05) at various stages of hemorrhagic shock.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

An analysis of electrocardiograms (ECG lead II) obtained following blunt thoracic impacts conducted on 12 anesthetized pigs indicated that all animals developed some degree of trauma to the heart conducting system: sino-atrial nodal disturbances, atrio-ventricular junctional dysfunction, intraventricular conduction defects (e.g., bundle branch blocks), or ventricular fibrillation. The induced ventricular fibrillation proceeded rapidly to the demise of four animals in this study. A comparison of the occurrence of ventricular fibrillation with measured biomechanical response parameters indicated a significant correlation of ventricular dysfunction with high levels of sternal acceleration (930 g) and impact velocity (10.7 m/s). The initiation of ventricular fibrillation did not correlate with typical biomechanical thoracic injury “indicators” (i.e., level of normalized thoracic deflection, cumulative AIS, peak spinal acceleration, or applied force). An injury severity classification (MCD) was subsequently developed for the evaluation of myocardial conducting system dysfunctions.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID