摘要:

In an experimental study in dogs of the anterior tibial compartment syndrome, three measurements were taken before, during, and following raising pressure in the compartment: blood flow, muscle function, and peroneal nerve conduction. If fasciotomy was performed within 4 hours, peroneal nerve conduction velocity always returned to normal regardless of amount of pressure or length of time pressure was applied; if performed after 12 hours peroneal nerve conduction velocity did not return to normal at any pressure or time condition, suggesting that irreversible damage to the nerve had occurred. Blood flow, as measured by rate of clearance of Xe133, always returned to normal within 2 hours of fasciotomy regardless of the time postinjury or amount of pressure applied. Muscle function (CPK and LDH) did not always return to baseline with fasciotomy and in some instances the absolute values were higher after fasciotomy. Further clinical studies using these measurements are recommended.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Effective prehospital treatment of the severely injured and acutely ill by an Advanced Emergency Care system may change symptoms and signs by the time patients arrive at the hospital. To provide optimal care, physicians must appreciate the capabilities and limitations of the EMT-paramedic. The EMT-paramedic must report verbally and via written record the course of prehospital events. Cardiac rhythms must be documented for review. It should be the responsibility of the medical directors of such Advanced Emergency Care systems to provide supervision, refresher training, critiques, and evaluation, to establish medical responsibility and credibility.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

In the presence of impaired renal function a number of pharmacologic agents require dose adjustments to avoid toxicity. Physician dose variations of a wide range of pharmaceuticals, 237 orders for 30 drugs for 107 patients, were compared to doses recommended by a computer program which considers renal function in calculating its dose. Disagreement in dose regimens was evaluated by comparison of physician-dose to computer-dose for three classes of drugs: wide range, narrow range, and 80% renally excreted. With true renal impairment (serum creatinine ≥1.2 mg/100 ml and creatinine clearance <80 ml/m) significant overdosing occurred for narrow range and 80% renally-excreted agents, 83 and 77% respectively. There is a great potential hazard observed to be avoided. It is recommended that dose adjustments for nephrotoxic or renally-exereted agents be implemented using creatinine clearance (estimated or measured) with, at the very least, manufacturer's recommendations.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Enterobacter cloacae sepsis was found in 15 burn center patients in 1976, of whom 13 died. Nine of the deaths occurred in the first 60 days. The Burn Center isolates were resistant to silver sulfadiazine (AgSD) in agar cup-plate tests and confirmed by tube dilution tests. Hospital, non-burn isolates ofE.cloacae were sensitive to AgSD. AllE.cloacae isolates were sensitive to mafenide acetate (MA) in the agar cup-plate tests, but this was not confirmed by the tube dilution tests. The agar cup-plate susceptibility test is a simple, rapid and effective technique for determining resistant and sensitive isolates ofE.cloacae. Patients who were changed from AgSD to MA because of resistantE.cloacae infection did not have improved survival. An animal study showed that AgSD was ineffective against this strain ofE.cloacae and that MA was more effective than AgSD when applied 24 hr postburn but neither were effective at 48 hr postburn. MA was bacteriostatic but not bactericidal with thisE.cloacae strain.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Experience with 105 lower limb arterial injuries in 103 patients in a general hospital is described. The pathology is discussed: it is noted that spasm per se could not be incriminated as a cause of ischemia. Management of the injuries and associated fractures is outlined. A plea is made for use of external fixation in compound injuries. An aggressive approach to the degloved limb, open three-compartment fasiotomy for severe vascular injury with signs of ischemia, and delayed primary closure for wounds with septic complications are recommended. Associated soft-tissue injury requires arterial reconstruction even in the presence of muscle rigor and anesthesia.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Five cases of fracture of the lateral humeral condyle in children are described to illustrate the importance of recognition and proper management of this injury. The cases represent different degrees of severity of this injury. Failure of recognition of this fracture leads to serious late complications. Management of missed and maluniting fractures is discussed. It is our practice to internally fix these injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Adult male rats maintained on a low calcium intake during 6 weeks prefracture developed osteoporotic changes of the tibia fracture during a healing period of another 6 weeks.Treatment based on combined use of daily peroral doses of 1α-hydroxycholecalciferol and an optimal calcium intake reversed the osteoporotic changes in the fractured tibia after only 2 weeks, and the act of reversion became still more pronounced after 4–6 weeks.1α-hydroxycholecalciferol treatment is recorded, when supported by an optimal calcium intake, to positively influence the levels of serum calcium, dry weight, and total ash content as specific weight and cortical thickness of the fractured tibia, following experimental fractures.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Contamination of blood by bowel contents has been generally assumed as an absolute contraindication to autotransfusion. Since abdominal trauma is frequently accompanied by bowel injury and massive blood loss, a potential major use for autotransfusion has thus been precluded. To test this presumption, autologous blood grossly contaminated with feces was incubated in the peritoneal cavity and then autotransfused in dogs. The animals were hemorrhaged 20, 30, or 40% of their estimated blood volume, producing mild to severe hypovolemic shock. Reinfusion of contaminated blood had little effect on survival with 20 or 30% hemorrhage, but contamination markedly decreased survival with 40% hemorrhage:90% survived without contamination while only 30% survived with contamination. The use of antibiotics in a similar group of dogs subjected to 40% hemorrhage essentially eliminated the risk of autotransfusion: 90% of these dogs survived autotransfusion of contaminated blood.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Of 32 patients in shock and catabolic state following shock with impaired consciousness 31 exhibited raised sodium content in their erythrocytes. On the assumption that the erythrocyte membrane acts the same as nerve cell membrane, the hypofunction of erythrocyte membrane may result in impaired consciousness. The hypofunction of erythrocyte membrane is assumed by its increased permeability in shock. A positive osmotic discrepancy between measured and calculated levels denotes altered membranous permeability.Subjectively, impaired consciousness was evaluated by clinical grading. Meanwhile, as a trial of quantification of conscious levels, we applied a new technique of analysis of power spectrum obtained by computer on the autocorrelogram of the EEG during intermittent photic stimulation. This new analytic method was useful in evaluating objective changes of cerebral function. There was a good correlation between raised sodium content in erythrocytes and depressed power spectrum. The degree of increased sodium in erythrocytes seems to correlate with patients' clinical prognosis.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

The bitemporal flap meets the increasing demand for esthetic reconstruction of forehead defects. The surgical technique, applied anatomy, and plastic surgery principles are reviewed. Illustrative case histories review the application of the bitemporal flap reconstruction technique.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID