摘要:

Using disulphine blue, sheep tibial cortex perfusion was decreased by subperiosteal stripping but not by extraperiosteal exposure. Semitubular plates applied with either low (20 kp) force, sufficient for extraosseous vascular occlusion, or high (200 kp) force, similar to that used clinically, both produced significant ischemia beneath the plate. In contrast, the dynamic compression plate produced significantly greater ischemia only with the higher force.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

We present the first in a series of five papers from the Departments of Biochemistry and Surgery, State University of New York at Buffalo, in this issue, and plan to have the remaining papers in the series in the next four issues of the Journal.The first two papers are longitudinal studies of a single trauma patient from admission to death; the other three are collective studies on survival versus death from a septic trauma episode and the observations associated with amino infusion, albumin infusion, and the response of the plasma proteins.(Eds.)This is a longitudinal study of the basal cardiopulmonary function, plasma concentrations, and splanchnic extractions of a patient with severe trauma with associated oliguric renal failure, who was supported on 5% glucose and albumin from admission to death with a massive pelvic abscess. Twenty-nine blood cultures were negative. The measurements show, apart from the initial and terminal states, adequate cardiopulmonary function with vigorous support. They also show that the post-shock trauma adaptive phase (days 4 to 10) was one of high but reducing splanchnic extraction of a largely balanced mixture of amino acids in association with rapidly decreasing carbohydrate and increasing fat catabolism. Compared to overnight normal fasting subjects, the means of 13 basal arterial analyses on the patient were significantly lower for threonine, serine, glycine, alanine, isoleucine, ornithine, lysine, histidine, and arginine, and significantly higher for phenylalanine, tryptophan, lactate, free fatty acid, glucose, acetoacetate, and triglycerides. The tyrosine-phenylalanine ratio was much reduced and the tryptophan to LNAA ratio much increased. Some plasma substances showed a marked increase in concentrations starting at day 10 (proline, an unknown 'fast cystine,' glutamate, aspartate, α aminobutyrate). Clinically, days 10–11 were considered a transition period between the trauma adaptive phase and initial septic phase. The septic phase was one of rapidly reducing fat catabolism in association with increasing glucose catabolism and splanchnic extraction of a largely unbalanced mixture of amino acids which was rich in tryptophan and proline and deficient in isoleucine. Such a mixture would reduce protein synthesis while stimulating gluconeogenesis. The statistical significance of the preceding statements and associated changes is explored in detail on more than 6,000 plasma analyses. The observed changes are consistent in the septic phase with a muscle fuel deficit which enhances branched chain oxidation while relating muscle atrophy to liver failure to peripheral circulatory failure to the lethargic state. The fact that less splanchnic catabolism of amino acids accompanies increased splanchnic concentration of substances which are good muscle fuels implies that the energy needs of muscle have a primary role in substrate priorities in the trauma-septic state, whereas the splanchnic system has a secondary role. This latter interaction is defined as a muscle-liver-fuel cycle.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The effect on nonpenetrating hepatic injury of varying impact velocity was investigated in a series of abdominal impact experiments with rabbits. In these tests, a constant level of 16% anteroposterior compression was produced by a flat aluminum disc driven by a pneumatic impactor at velocities of 5 to 20 m/s to investigate an impulsive as opposed to a crushing mechanism of injury. Laceration of the liver regularly occurred for impact velocity and available energy greater than 12 m/s and 9.1 joules, respectively (p < 0.01). In addition, a gradation of hepatic injury, probably caused by local strain energy density in the soft tissue, was observed through the range of impact velocity, i.e., minor subcapsular contusion at low velocity to extensive deep laceration and hemoperitoneum at high velocity. With impact applied only to the abdomen, there were associated thoracic and renal injuries at impact velocities >14 m/s. The Abbreviated Injury Scale (1) was extended for classification and quantification of injury.The peak reactive force, peak esophageal pressure, and impulse transfer increased with impact velocity. It appears that there may be two regions of biomechanical response, one at 12 m/s or below, and one at >12 m/s.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The effect of alcohol on the injured spinal cord in cats is assessed by use of a standardized trauma model at both nonparaplegic and paraplegic trauma forces. Prior administration of an intoxicant dose of ethyl alcohol resulted in a potentiation of the trauma response at the 100 gm-cm and 260 gm-cm contusion levels. No significant changes were noted at the higher trauma grades. The results suggest that alcohol acts synergistically with mechanical injury of the spinal cord to amplify the trauma response by increasing edema formation within the contused tissue. The mechanism by which this potentiation may occur are possibly in the areas of antidiuresis and fluid retention from increased tissue hydration in alcohol-treated animals.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Previous studies have demonstrated that the injection of homologous hemolyzed blood, and reticuloendothelial system (RES) clearance of the erythrocyte membrane debris, depress RES phagocytic function and increase shock susceptibility. This study was carried out to determine if the degree of intravascular hemolysis following experimental thermal injury was comparable to the dose of hemolyzed blood required to depress RES function. The IV injection of graded doses of hemolyzed blood into rats demonstrated that 0.2 ml/100 gm of hemolyzed blood was the minimum dose of hemolyzed blood which would cause an RES depression. This volume of hemolyzed blood was equivalent to 2.8% of the blood volume of the animals studied. Hemolysis was assessed from the plasma hemoglobin and blood volume following graded thermal injury in anesthetized animals. Thermal injury which caused an 80% mortality rate was associated with the acute hemolysis of 3.1% of the blood volume. Thus the degree of hemolysis caused by thermal injury may generate sufficient erythrocyte membrane debris to induce RES depression and thereby impair host defense.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Trauma Recovery is a developing organization which focuses on the psychosocial concerns of those recovering from multiple trauma. Utilizing the self-help group concept, recovering trauma patients participate in a program which enables them to help one another in dealing with the long-term consequences of their injuries. Components of the program include group counseling, education, socialization, and outreach to others in similar circumstances.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The urinary output of 3-methylhistidine (3-MeHis), creatinine, creatine, and zinc has been followed in 13 patients after accidental injuries and in nine patients undergoing elective orthopedic operations. The accidental injuries were classified by their Injury Severity Score (ISS) and according to the amount of muscle damage by the method of Grant and Reeve (15). The latter method gave two groups, (I) 'very severe,' and (II) 'severe.' The changes in the urine were not related to ISS. The initial output of 3-MeHis and zinc was greater in Group I than in Group II or in patients after total hip replacement, in whom muscle damage was least. The pattern of excretion of the excess 3-MeHis in Group I and after hip replacement suggested that it was derived from the breakdown of muscle injured in the accident or operation. Only in Group II and after total knee replacement were there additional changes which could be attributed to a generalized increase in muscle breakdown, said to be typical of the post-traumatic 'flow' phase, e.g., the simultaneous increase in the output of all four muscle markers, to a peak about 6 days after the injury. In these patients the relative importance of muscle at the injury site and elsewhere is not clear. The most constant changes after accidental or operative trauma were delayed increases in the excretion of creatine and zinc. These changes, and the abnormality of the 3-MeHis/creatinine ratio, showed that alterations in muscle metabolism could persist for long periods after trauma.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

In a study of 209 patients who had serum drawn for assay of creatine phosphokinase (CPK) isoenzymes, an attempt was made to correlate elevation of CPK brain fraction (BB) with occurrence of brain injury and to evaluate its sensitivity as an indicator of the presence of brain damage. Thirty-three patients had suffered serious head trauma. However, of the ten patients in coma, only three had elevated serum CPK-BB levels. Twenty-four of the other 176 patients who had no history of head injury also had positive BB fractions. Serum CPK-BB level was therefore an unreliable indicator of the extent of brain damage.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

In 11 subluxations and four dislocations of the hip, following the internal fixation of intracapsular or intertrochanteric fractures, sepsis was proven in 12. Subluxations were diagnosed radiographically between 2 and 26 months following injury. Dislocations occurred following unstable intertrochanteric fractures, stabilized by valgus reduction, medial displacement, and osteotomy of the greater trochanter, and were diagnosed between 10 days and 9 weeks post-fracture. Treatment alternatives included implant removal, resection arthroplasty, and replacement arthroplasty in selected cases.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID