摘要:

In commemorating and honoring the work of Everett Idris Evans we note the extraordinary developments in burn care which have taken place in intravenous therapy, control of infection, skin coverage, metabolism and diet, and the minimization of scarring and deformity. Probably a more important consideration is the emotional care of the burned child in relation to his grievous injury and disfigurement, to his relationship with his family and to his own expectations and those of all those in contact with him for his future, both social and economic. Without this emotional care we must confess that burn care is incomplete.References are made to the way in which the whole child should be cared for by the whole burn team and the principles underlying this. A special note is made of times of crisis to be encountered.The correct approach by trained people from the beginning of the illness and their patient continuation of contact as long as necessary will enormously reduce the suffering of both the patients and their parents and will avoid many tragedies.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The restoration of normal immune responses is a clinical goal in the severely immunosuppressed burn-trauma patient. The recently documented emergence of the suppressor system following major burns, however, dictates caution in the use of agents which stimulate immunologically competent cells. We describe an in vitro system, utilizing human peripheral lymphocytes, which accurately reflects the degree of immunosuppression of burned patients, and which can be used to predict the effect of immunologically active agents. Of a group of synthetic polyribonucleotides tested in this system, Poly I:C produced a significant favorable modulation in doses of 3.7 micrograms/ml. The most marked effect was noted in the subgroup of patients who eventually succumbed and in whom clinical modulation would be most advantageous.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

This study assessed the effects of blunt trauma on host defense, including the early kinetics of skin test anergy (A), depressed polymorphonuclear neutrophil (PMN) function, the duration of these changes, and the effect of the nutritional status of the host upon resolution of these defects. Of 31 patients sustaining blunt trauma six (19%) had normal (N) skin tests with no sepsis or death; 25 (81%) demonstrated skin test A with 20% sepsis and 16% mortality (p< 0.001). The severity of the injury correlated directly with the duration of depressed host defense. Abnormalities of PMN chemotaxis and adherence were detectable within 2 hours of injury and were due to circulating blood factors. No gross abnormalities in serum immunoglobulins or complement levels were detected upon admission. The PMN chemotactic inhibition in the serum of these patients was resolved into at least five components varying in MW from 8,000 to > 400,000 daltons. In 11 patients whose skin test responses returned to N in 19 ± 8.3 days (±SD), albumin dropped 0.46 ± 0.30 gm/dl, arm muscle circumference decreased 2.93 ± 1.69 cm, and creatinine height index dropped 30.1 ± 18% from ideal, during the same interval (p< 0.001). Nonseptic patients (18) were at risk from depressed PMN function 20.6 ± 9.3 days, 74% had central lines, operations were ‘clean,’ and 2.8 blood cultures/patient were drawn with no bacteremias. Septic patients (four) were at risk 53.9 ± 9.5 days, all had central lines, operations were 'clean,' 7.8 blood cultures/patient were drawn with 1.7 bacteremias/patient detected. We conclude that blunt trauma causes an immediate depression of host defense which is mediated by a complex system of serum modulators of neutrophil function. Restoration of these defects follows resolution of trauma rather than the nutritional and catabolic state.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Twenty-three patients, ranging in age from 4 months to 80 years, who suffered open brain injury with loss of at least 4 cm2of cerebral cortex, and who underwent surgery, have been followed until their death or from periods ranging from 3 to 16 years. Gunshot wounds and open or depressed fractures with smaller lacerations of the brain were not included. The principles of surgical management important for the preservation of life and the retention of maximum brain function have been employed: debridement of all necrotic tissue after thorough irrigation and cleansing, then reconstitution of all tissue layers as completely as possible. The causes of death in three patients as well as of complicating factors in the 20 survivors, such as organic dementia, posttraumatic psychosis, paralysis, cerebral sensory loss, and epilepsy, are reviewed.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The charts of 175 patients who underwent emergency thoracotomy (ET) in the emergency room (ER) between 1972 and 1978 were reviewed to determine the efficacy of this procedure. Seven cases of nontraumatic cardiac arrest were excluded from analysis. Although 150 patients were transported to the ER within 1 hour of injury, 60% either had no vital signs (91 cases) or were agonal (20 cases) on admission to the ER. The trauma was blunt in 60 cases and penetrating in 108. The major sites of injury were heart, major vessels, head, liver, and lung. Thirty-six patients died in the ER, 83 died in the operating room, and eight of the remaining 49 patients who survived operation died acutely in the immediate postoperative period. Of the patients who survived beyond 24 hours after injury 80% recovered and left the hospital: overall 19.6% survived. If patients with irreversible head injuries are eliminated, 24% survived. Correlation of admission status with outcome revealed the following survival rates: no vital signs (6.6%); agonal (20%); profound shock (34.1%); and mild shock with subsequent deterioration (56.3%). Survival rates were higher for patients with stab wounds (40%), pericardial tamponade (38%), and injury to the heart (30%), or lungs (57%). A cost-benefit analysis revealed that total benefits were 2.4 times greater than total costs. Performing early thoracotomy in the ER is a life-saving measure for a substantial number of trauma patients who present to the ERin extremis.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The measurement of pulmonary vascular pressure and plasma oncotic pressure (πp) is reported to be useful for predicting excess fluid transport across the pulmonary microcirculation in the critically ill. However, interpretation of change in these forces must take into consideration the compensatory changes in the other Starling forces, particularly interstitial oncotic pressure (πi) and the permeability characteristics of the membrane. We calculated pulmonary microvascular pressure Pmv, πp, and πi in unanesthetized sheep with lung lymph fistulae. We altered Pmv by fluid loading and πp by producing a severe hypoproteinemia after hemorrhagic shock and altered the membrane with endotoxin. We compared these with changes in the pulmonary transvascular fluid filtration rate (&OV0422;f). We found Pmv correlated very well with &OV0422;fduring volume loading and during the post-shock hypoproteinemic state, πi decreased in response to decreases in πp, producing a relatively constant oncotic gradient (πp-πi). πp then correlated very poorly with &OV0422;fwhen hypoproteinemia was present. There was essentially no correlation between any of the pressures and &OV0422;fafter the severe permeability change produced by endotoxin.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

On 21 May 1975 a chartered bus carrying 51 members of a student choir rolled from a sharply curved freeway off-ramp and fell 22 feet, landing on its roof, which collapsed. Twenty-nine passengers died (25 before extrication) and 22, plus the driver, survived. An analysis of factors leading up to the accident reveals several contributing causes, among them inadequate design of the ramp, poor warning signs, driver inexperience with the bus, and deficient bus maintenance. Bus design itself contributed to the lethality of the event. Structural support for the roof was inadequate and no access was available to the interior for extrication of victims. Problems with organization at the scene, triage, and communications among agencies involved in the rescue and receiving hospitals contributed to confusion in the transport of victims, although it appears this had little impact on outcome. An analysis of the accident allows several lessons to be learned which might prevent, or reduce, the fatalities from future accidents involving multipassenger vehicles, and other disasters with 10 to 25, or more than 25 fatalities. In the present report ten of 25 killed were judged possibly salvageable with immediate extrication.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Disruptions of the extensor mechanism of the knee most commonly involve fracture of the patella. Less frequently, patellar and quadriceps tendons are ruptured either spontaneously or by trauma. Surgical reconstruction of these tendon injuries is complicated by the difficulty in completely neutralizing tensional force across the repair. To overcome this problem, methods have been developed to reinforce the repair with overlapping flaps or fascia lata. Others advocate wire sutures or loops to relieve the tension. These techniques prolong and complicate the initial procedure and in some methods require a secondary operation for removal of wire sutures. To simplify these repairs we have developed a method of end-to-end repairs using 5-mm Dacron polyethylene terephthalate fiber strips manufactured under the trade name of Mersilene (Ethicon, Somerville, NJ). The results of our first ten cases are presented.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Forty-four children suspected of having been abused underwent Tc-99mdiphosphonate bone imaging at the time of initial presentation for treatment of trauma or burns. Twenty-six had negative scans. These patients never showed X-ray evidence of skeletal injury although ten were abuse victims. Two skull fractures were found on X-ray examination when the scan was normal.Initial roentgenograms confirmed the presence of bone injury in 11 children with positive scans. Five of seven children with positive scans and normal initial X-rays developed bone or periosteal lesions visible on later X-ray studies. One of the remaining two children was lost to further study and the other had a history suggesting a prior injury which might have healed sufficiently to yield normal X-rays.In the study of children suspected of having been physically abused, the skull should be X-rayed and a bone scan performed. The scan can identify which additional bony areas to study roentgenographically on the day of first medical encounter, and which areas to re-study should the initial roentgenograms appear normal.Bone scanning, using technetium 99mdiphosphonate is more sensitive than the roentgenographic skeletal survey in detecting early evidence of bone or periosteal injury.The evidence thus obtained is useful for protecting children from further abuse, either by court action or, more commonly, by effective counselling after the abuser's denial has been overcome.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

A series of 100 consecutive patients with pertrochanteric hip fractures treated by the Ender method of intramedullary nailing is reported. The average age of the patients was 77.26 years (range, 34 to 94 years). Followup of the patients was from 4 to 15 months, with an average of 7 months. The mortality rate was 9% and the rate of serious complications was 8%. All fractures of the 50 patients followed were healed at 4 months and the functional results were generally good. This method appears to offer excellent results and may be the result of fast operating time, minimal surgical trauma, and ease of performance.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID