摘要:

A prospective study of thyroid function was performed in 25 thermally injured patients. These patients are divided into two groups. The first group contains five patients with greater than 50% burn size studied longitudinally during the first 15 days following thermal injury. Significant suppression of serum concentrations of 3,5,3′-triiodothyronine (T3) and elevation of serum concentrations of 3,3′,5′-triiodothyronine (rT3) were seen. The free thyroxine index and serum TSH concentrations remained within the normal range. To assess the clinical significance of these alterations in peripheral thyroid hormone concentrations, a second group of 20 patients was studied. We measured the free serum levels of T4(FT4) and T3(FT3) in ten patients, mean age 34 years, mean burn size 56%, studied during a period of clinical deterioration, and in ten patients of comparable age and burn size who were clinically stable. Both FT4and T3values were significantly lower in the unstable patients (p< 0.01). All FT3values for the unstable patients (M ± SE) 193 ± 14 pg/dl, were below the normal range for FT3of 230 to 669 pg/dl, and significantly lower than those observed in the stable patients (M ± SE), 430 ± 59 pg/dl (p< 0.001). This correlation of biochemical hypothyroidism with clinical deterioration may have functional significance for the critically ill trauma patient.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Decreasing progressive dermal ischemia after burning could theoretically limit the amount of skin necrosis to the zone of coagulation.Methylprednisolone, aspirin, indomethacin, imidazole, dipyridamole, and methimazole have been shown to prevent dermal ischemia, suggesting that prostaglandins and/or thromboxanes may play a role in its pathogenesis. Specific antiprostaglandin antibodies (anti-PgE2, PgF2a, Pgl2, and TxA2) were reacted with tissue biopsies of burned guinea pig skin at various time intervals postburn. An immunoperoxidase technique with goat anti-rabbit immunoglobulin and horseradish peroxidase demonstrated the presence of the specific arachidonic acid metabolites. The burned tissue showed high levels of PgE2and TxA2. The effects of three thromboxane inhibitors, imidazole, methimazole, and dipyridamole, on dermal ischemia were studied. Xenon133washout studies were performed in burned and unburned areas. Tissue half-life of Xenon was prolonged in burned, untreated areas but this rapidly decreased in antithromboxane-treated burns. Repeated antiprostaglandin and antithromboxane antibody-immunoperoxidase studies on tissue from the thromboxane inhibitor-treated animals showed that PgE2, PgF2a, and Pgl2were at the same levels as in untreated animals, but thromboxane (TxA2) was essentially absent, suggesting that thromboxane may be responsible for the progressive dermal ischemia after burning and that decreasing its production can increase dermal perfusion.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Deficiency of opsonic α2surface binding (SB) glycoprotein (cold-insoluble globulin, plasma fibrinectin) is related to depressed reticuloendothelial function as well as to multiple organ failure after tissue injury and sepsis. Cryoprecipitate (250 ml), extracted from 10 units of human plasma, was infused over 60 minutes into 11 hypo-opsonemic patients with decreased renal function. Cardiac output, mean arterial pressure, creatinine clearance, and limb blood flow were measured before and at intervals of 14 to 20, 35 to 44, and 60 to 66 hours following cryoprecipitate infusion. Before infusion, the mean creatinine clearance was 30 ± 4 ml/min/M2body surface area (BSA) and increased to 40 ± 6 ml/min/M2BSA at 14 to 20 hrs (p< 0.05); to 40 ± 4 ml/min/M2BSA at 35 to 44 hrs (p< 0.05); and to 40 ± 5 ml/min/M5BSA at 60 to 66 hrs (p< 0.05). In contrast, mean arterial pressure and cardiac index at each time interval showed no significant changes from the pretreatment values of 81 ± 6 mm Hg and 3.4 ± .2 L/min/M2BSA, respectively. Limb blood flow increased significantly at 4 hours and returned to control values by 35 to 44 hours. Thus cryoprecipitate infusion to critically ill trauma and surgical patients with depressed renal function may improve glomerular filtration rate independently of mean arterial pressure or cardiac output. This improved renal function may be related to increased reticuloendothelial clearance of blood-borne particulates and/or improved microcirculatory function and lends support to the concept that RES failure may be involved in the etiology of multiple organ failure secondary to combined tissue injury and sepsis.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Records of 100 consecutive patients treated in 1973 through 1977 with post traumatic retroperitoneal hematomas (RH) were studied. Eighty RH followed blunt injury and 20 were due to penetrating trauma. Overall mortality was 26%. The worst prognosis was associated with RH from automobile accidents and pedestrian injuries. Pelvic RH were almost uniformly associated with pelvic fracture and were the primary cause of 39% of deaths. Blunt perinephric RH required renal exploration in 47% of patients. Blunt RH in other locations were associated with major visceral or vascular injury in half the patients and were the cause of death in five. Sixty-five per cent of RH due to penetrating trauma had visceral or vascular injury requiring operative correction. Contained rupture of descending thoracic aorta presented as retrogastric RH in two patients. RH from penetrating trauma should be explored routinely, since 65% are associated with visceral or vascular injury.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Contrary to prevailing views, documentation of major morbidity after venous ligation for trauma is sparse. Forty-six patients had ligation for injury to the major veins of the lower extremities, namely, vena cava (six), external iliac (five), common iliac (three), common femoral (eight), profunda femoris (six), superficial femoral (thirteen), and popliteal (five). The post-ligation management included: 1) early and extensive fasciotomy when indicated, 2) initial strict bed rest with elevation until edema free, 3) trial ambulation for 2 hours, 4) added elevation if trial ambulation leads to recurrent edema.Forty patients were discharged edema free, and six patients had mild edema. Followup examination in 39 patients revealed no edema in 30 patients, mild edema requiring no treatment in one patient, and moderate edema requiring support hose in eight patients. No severe or massive edema causing ulceration or ischemia occurred. Based on these findings, primary venous interruption is a safe, quick and effective means of managing venous injury whenever the extent of injury or the severity of associated injuries make primary repair hazardous.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Sympathectomy has been advocated in the therapy of acute frostbite because ischemia is one determinant of injury severity. Among 66 frostbite victims treated from 1976 through 1978, a group of 15 patients with acute, bilaterally equal injuries judged to be third or fourth degree were treated with immediate intra-arterial reserpine (IAR) in one limb and ipsilateral sympathectomy. Three additional patients who were excellent candidates underwent immediate sympathectomy. The average interval from injury to IAR injection was 3 hours (range 1 to 24 hours). The average interval from injury to sympathectomy was 3 days (range, 12 hours to 10 days). Efficacy of therapy was assessed by comparison of the sympathectomized limbs to the contralateral untreated limb. There was no conservation of tissue, resolution of edema, pain reduction, or improved function in sympathectomized limbs compared with those treated with IAR. One patient demarcated more rapidly and one other patient appeared to be protected from recurrent injury. Sympathectomy was not effective therapy for acute frostbite even when achieved early with IAR. Late protection against subsequent cold injury appears to be the only benefit of sympathectomy for frostbite.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Protein depletion in rats is associated with hemoconcentration, diminution of red cell mass, and suppression of erythropoiesis. In a rat model, repletion with standard diets or total parenteral nutrition was associated with gain in body weight and regeneration of red cell mass. Hematocrit values did not reflect the degree of red cell mass diminution associated with protein depletion. Intravenous repletion of normal and protein-depleted rats, unlike oral refed cohorts, was associated with elevated 2,3 diphosphoglycerate (DPG) values and a ‘relative anemia.’ It is postulated that elevated red cell 2,3 DPG lowers the hypoxie stimulus for erythropoietin production by enhancing oxygen unloading to the tissues, thus partially compensating for the anemia associated with total parenteral nutrition.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Changes in muscle high-energy phosphates in varying degrees of resting hypermetabolism were studied. Eleven patients were investigated before and 4 days after total hip replacement. The postoperative results were compared with those seen in major trauma and sepsis.High-energy phosphates were not significantly changed in muscle after total hip replacement or moderate injury; muscle lactate and pyruvate increased. Increased degrees of hypermetabolism such as severe trauma and sepsis were associated with reduction of muscle ATP and PC; AMP, free CR, lactate, and pyruvate rose. Simultaneously determined levels of high-energy phosphates in red blood cells did not reflect muscle changes, confirming the need for continued direct tissue measurements. Alterations in the ATP–ADP–AMP system in the muscle cell suggest a low-energy charge following severe trauma especially if accompanied by sepsis. This would indicate a decreased capacity for biosynthetic reactions and production of storage compounds. Tissue high-energy phosphates and cellular energy levels thus may be the cellular expression of the catabolic state.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

At Metropolitan Hospital Center, New York City, 3,000 patients with trauma were admitted during 1974 through 1978, with a mortality rate of 4%. One hundred eight patients who were admitted and died were analyzed. Ages were from 3 months to 84 years with clusters in 15–30 and 45–60 years. Injury Severity Scores (ISS) ranged from 9 to 66 (37). All body systems were equally represented. Most patients had two systems involved. Abbreviated Injury Scale (AIS) scores for most severe systems were 5 in 60%, 4 in 34%, and 3 in 6%. Shock was present in 52%. Major complications: sepsis in 30% (pulmonary, 20%); neurological, 12%; respiratory failure 15%; renal failure 10%. Surgical care was optimal in 45%. In the remaining 55% at least one error occurred: inappropriate or inadequate fluid resuscitation, 37%; missed or delayed diagnosis, 20%; airway management, 10%; surgical judgment, 8%; surgical techniques, 9%. ISS scores, error/no-error; shock/no-shock, showed no significant differences. Patients with AIS scores of 3 were elderly or had errors in management.Management errors continue to be made in a significant number of severely injured patients, and may contribute to the demise of patients with survivable injury. These data parallel those reported to this society by van Wagoner (13) in 1960 and Foley in 1976 (5).

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Dust explosions occurring in grain elevator storage and processing operations are increasing in frequency and are a world-wide source of injury and fatality. Despite extensive investigation by both private and governmental interests, the causes of most grain dust explosions remain a mystery. A number of methods to help prevent such explosions have been developed, but none has gained uniform acceptance. Despite a brief contact with flame in the flash of a dust cloud ignition, temperatures may exceed 1,000 F and can cause severe burns. A single burn center's experience with eight patients injured in three separate grain elevator dust explosions during a 12-month period highlights the potential seriousness of the problem. Physicians practicing in grain producing or shipping areas of the world should be aware of the potential hazard imposed by grain storage operations. Prevention of these explosions by mandatory dust control systems and appropriate safety regulations is emphasized.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID