ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Ionized calcium (Ca2+) and ionized magnesium (Mg2+) are important intracellular “second messengers‘’ and control excitation-contraction coupling, excitation-secretion, oxidative phosphorylation, and mitochondrial acid-base balance. The present study examines the effect of septic shock on serum (Ca2+) and (Mg2+). Five adult female baboons were subjected to liveE. coliseptic shock and then resuscitated. Three baboons served as controls. Ca2+was measured by the Orion SS-20 flow-through calcium electrode and Mg2+calculated by the method of Killen. Other measurements included: total calcium, bound calcium, total magnesium, bound magnesium, phosphate, albumin, globulin, hemotocrit, and total protein.This study shows that there are significant disturbances of Ca2+and Mg2+during septic shock in the baboon. These disturbances may in part explain cellular dysfunction during shock including: decreased myocardial contractility, inappropriate secretion of endocrine cells, decrease in oxidative phosphorylation, and mitochondrial acidosis.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Thirty-four cases of duodenal trauma, 23 caused by gunshot wounds, are reviewed. All but three patients had associated major organ injuries, a total of 97 injuries. Postoperative mortality was 14% for injuries into the duodenal lumen. Techniques for operative repair included simple primary closure, use of omental or serosal patches, controlled fistula with a duodenostomy tube, decompressive and feeding ostomies, “diverticulization,” segmental duodenal resection and anastomosis, and total duodenectomy and pancreatectomy. It is emphasized that the surgeon finding duodenal injury must be familiar with all of these techniques, each of which has its indications. Treatment of duodenal injuries perhaps more than any other bowel trauma must be individualized.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

One hundred three pregnant women hospitalized following blunt trauma had injuries classified as: major (20%); minor (17%); or insignificant (63%). Maternal mortality related only to the severity of maternal injuries: 24% of women who sustained major injuries died. Pregnancy ended unsuccessfully in 18% of all women with known pregnancy outcome. The incidence of unsuccessful pregnancy was 61% following major injuries and 27% following minor injuries. Insignificant maternal injuries did not affect pregnancy outcome. Fetal survival did not relate to gestational age per se. Pregnancy uniformly ended unsuccessfully in the presence of maternal death, placental injury, uterine injury, and direct fetal injury, and occurred in 80% of women admitted in hemorrhagic shock. An understanding of the ways that the anatomic and physiologic changes of pregnancy alter the nature and frequency of maternal injuries and that maternal response to injury is altered is essential. The best chance for fetal survival is to assure maternal survival.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

This paper presents a simple method of maintaining good donor organ oxygenation during a prolonged test of apnea used to determine brain death prior to cadaver transplantation. Apneic diffusion oxygenation can maintain arterial pO2above 200 torr for periods exceeding 15 minutes, thereby allowing a more definitive determination of brain death without concomitant tissue hypoxia and possible damage to donor organs.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Twenty-two of 604 patients (4%) with pelvic fracture (PF) had open fractures. Eight per cent of all pedestrian and motorcycle accidents resulted in open PF, compared to 0.8% of all vehicular accidents. With one exception, all patients sustained multiple injuries. The mortality rate for an open PF was 50%, in marked contrast to 10.5% for a closed PF. Of more importance, the pelvic fracture was the primary cause of death in 73% of those dying with an open PF and in 30% of those dying with a closed PF. The higher mortality is due to an increased risk of infection and to massive hemorrhage because of a high risk of concomitant major vessel injury, as well as increased diffuse retroperitoneal hemorrhage, in these open fractures. Therapy directed to restoring blood volume, identifying and repairing major vessel injury, and attempting to decrease the diffuse retroperitoneal hemorrhage is essential. If drainage is necessary, it should be accomplished with a closed system. Immediate colostomy and use of antibiotics should decrease the infectious complications.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

The addition of an inhalation injury to a cutaneous burn results in a significant increase in patient mortality rates, both from early pulmonary edema and, later, Gram-negative pneumonitis. Steroids have been shown to decrease mortality in an inhalation injury model. Aerosolization of gentamicin has been used successfully to treat severe bronchial infections. Therefore, a prospective, randomized trial was undertaken to evaluate both these drugs. Sixty burned patients, with inhalation injury confirmed by bronchoscopy and133Xenon scan, were studied: 30 patients received either dexamethasone or saline placebo for 3 days; serial pulmonary functions were measured on those able to cooperate; another 30 patients received either aerosolized gentamicin or placebo for 10 days. Both drug-treated groups were comparable to their controls in age and mean burn size. Results of the steroid trial showed no major differences in mortality, pulmonary complications, or changes in pulmonary functions. Results of the gentamicin trial showed no major differences in mortality, time of death, or pulmonary and septic complications between treated and control groups.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Three problems the authors think important in replantation of untidy amputations are discussed based on our 99 replantations with the success rate of 92.6% over a 4-year period. To restore circulation in this type of amputation, such techniques as transfer of blood vessels, use of a neurovascular island flap with neurovascular anastomoses at its distal margin, vein graft, and free split-skin graft directly on the anastomosed blood vessels are recommended. Recovery of tendon gliding when replanted proximally to the MP joint was reasonably good but not when replanted distally to it. Recovery of intrinsic muscles was generally poor. Protective sensation was usually regained, although occasionally accompanied by paresthesia. Amputation of single digit was found not to be an absolute indication for replantation except for the thumb. In multiple digital amputation, more important digits should be restored by amputated digits in better condition. Replantation for cosmetic improvement may be justified in such cases as unmarried young females. In infants, replantation is especially worthwhile because good functional recovery and good further growth can be expected.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Ten patients with 12 severe limb injuries managed by external skeletal fixation over 2 years are presented. Two major indications for external skeletal fixation divided the fractures into groups: A) extensively open fractures requiring wound care and closure by other than primary methods, and B) grossly unstable fractures requiring stabilization for soft-tissue support and fracture alignment. Group A was composed of five extremity fractures with skin and muscle loss and deep tissue contamination. Wound management was the primary problem. Wound closure, prevention of an infection, and limb salvage were the treatment goals in this group. Group B was seven severely comminuted extremity fractures with significant swelling and in some cases, questionable soft-tissue survival. Five were open, but not extensively. Instability was the primary problem. Fracture control, soft-tissue support, and limb salvage were the treatment goals in this group. Mean followup period for all fractures was 9.4 months. No amputations, deep infections, or deaths resulted. Wound care and closure were facilitated in all open fractures. Loss of contused tissues with marginal vascular supply was felt to be minimized. Delayed unions were common in both groups. Two malunions and one nonunion occurred. Treatment goals in both groups were accomplished.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Our experience with 829 patients with penetrating abdominal trauma treated in an Adult Trauma Service over 8½ years managed by “selective conservatism” is reviewed, and 207 additional patients with blunt abdominal trauma handled in the same fashion were also studied. This pattern of management prompted exploratory celiotomy in only 29% of stab wounds and 54% of gunshot wounds. Overall mortality for penetrating abdominal wounds, including patients moribund on admission, was 2.5%. Overall mortality was 19.3% for blunt abdominal trauma. There were no deaths or errors in management in those patients definitively selected for nonoperative management.The philosophy of using specific objective indications for abdominal exploration in both penetrating and blunt abdominal trauma, especially when bolstered by routine abdominal paracentesis and lavage, is safe and reliable, and is adaptable to all clinical facilities.

ISSN:0022-5282    

出版商:OVID    

年代:1978

数据来源: OVID