摘要:

Records of 132 consecutive patients with multiple musculoskeletal injuries were examined for the purpose of assessing the relationship between the length of time from injury to the operative stabilization of major fractures and the incidence of adult respiratory distress syndrome (ARDS). To be included in the study patients had to have had at least two major long-bone fractures and a Hospital Trauma Index-Injury Severity Score (ISS) of 18 or higher. Early operative fracture stabilization (STAB) is defined as an operation in the first 24 hours postinjury at which the majority of fractures were stabilized without leaving a spine, pelvis, or femur fracture unstable. A stepwise logistic regression was performed on the data. The dependent variable was the presence or absence of ARDS. The independent variables were age, sex, number of injuries, days to first surgery, early operative fracture stabilization (STAB), units of blood the first week, and ISS and its major components: RESP, ABD, CV, EXT, NS, and SSQ. The two independent variables selected as significant by this procedure were STAB and ISS. For the overall data set, a delay in orthopedic surgery (greater than 24 hours) is associated with a fivefold increase in the incidence of ARDS (p< 0.001). For the more severely injured patients (ISS > 40), the comparable rates are 17% with early surgery and 75% with delayed surgery (p< 0.001). A Chi-square test for association between ARDS and STAB adjusting for changes due to ISS grouping is significant (p< 0.001). In looking at the individual components of ISS it is seen that NS is the only one significantly associated with ARDS (p= 0.007).This study shows that there is a significant increase in the incidence of ARDS associated with a delay in operative stabilization of major fractures in patients with multiple orthopedic injuries. This is particularly true for more severely injured patients (ISS > 40). The ISS is of prognostic value in predicting the incidence of ARDS particularly when evaluating extremity (EXT) and neurologic (NS) injuries in the emergency room.

ISSN:0022-5282    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Infections in burned patients have generally been considered to arise from exogenous organisms. Consequently, the therapy of burned patients has emphasized the use of infection control policies and topical antimicrobial agents to reduce bacterial colonization. Even though enteric bacteria are frequently found in the burn wound little attention has been paid to the patient's own GI tract microflora as a potential source of organisms colonizing the burn wound. The current experiments were carried out to determine if the bacteria present in the GI tract of healthy animals would penetrate (translocate) through the GI mucosa and spread to visceral organs after a moderate or major thermal injury. The results of these experiments indicated that bacteria can translocate across the wall of the GI tract and survive in the mesenteric lymph nodes in healthy rats. Furthermore, when the GI tract microflora is altered, either due to bacterial overgrowth or under the influence of oral antibiotic therapy, not only will bacteria translocate to the mesenteric lymph nodes but bacteria will also spread to other visceral organs. The results of these experiments support the hypothesis that the GI tract can serve as a reservoir for nosocomial infections in the burned patient, since bacteria can translocate across the mucosal barrier of the GI tract after thermal injury and survive in visceral organs before colonization of the burn wound occurs.

ISSN:0022-5282    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Peritoneal lavage is the most valuable diagnostic modality presently available for the evaluation of patients with blunt abdominal trauma. A retrospective review of 523 patients who underwent open peritoneal lavage for blunt abdominal trauma over a 3/12-year period revealed serious intra-abdominal pathology in 83% of patients undergoing laparotomy with RBC lavage counts in the range of 20,000 to 100,000 cells/mm3, a level considered by many authors to be negative or indeterminate. Two patients with isolated small bowel perforations had an elevated amylase level as the only measured abnormality. The data indicate that the standard guidelines for RBC positivity (positive count > 100,000 cells/mm3and indeterminate count 50,000 to 100,000 cells/mm3) result in missed intraperitoneal injuries in a large percentage of patients and therefore require reevaluation. Lavage amylase determinations, previously stated to be costly and of insignificant yield, should be performed on patients whose lavage would otherwise be considered negative by RBC and WBC counts.

ISSN:0022-5282    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Diagnostic peritoneal lavage (DPL) was modified to detect dynamic changes occurring in lavage fluid in dogs following liver, spleen, or intestinal injury. In 33 animals lavage fluid was serially sampled over 75 minutes and analyzed for RBC and other variables. The spun sediment was Gram stained. In control groups, either saline or autologous blood was instilled into the peritoneal cavity at a known rate. In these experiments, the composition of lavage fluid did not significantly change over time. Blood infused at a constant rate into the abdominal cavity produced corresponding, continuing increases in the RBC count. In experimental groups, the liver, spleen, or intestine were injured before lavage. Only initial RBC counts greater than 1 million/mm3or rising RBC counts in serial lavage samples were associated with life-threatening hemorrhage. Gram stains of samples were positive for bacteria in 43% of fasted dogs and in 80% of fed dogs with intestinal perforation.

ISSN:0022-5282    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

We have previously shown thatCorynebacterium parvum (C. parvum), a nonspecific immunomodulator, partially protects splenectomized and nonsplenectomized mice when challenged with aerosolized pneumococci. We report here the effects of both splenectomy andC. parvumon the phagocytic function of the lavageable pulmonary alveolar macrophage (PAM).Groups of young adult male Sprague Dawley rats underwent splenectomy or sham operation 3 weeks before injection ofC. parvum1.5 mg IP (or saline) per animal. One week postinjection PAM's were harvested. The in vitro phagocytic indices (PI) for PAM incubated with tritiated thymidine-labeledS. aureusorStreptococcus pneumoniae, type 14, opsonized with normal rat serum, were determined.Splenectomy had no effect on lung weights, PAM yield, or PAM phagocytic activity.C. parvumadministration significantly increased spleen weight in sham-operated animals, but had no effect on lung weights, PAM yield, or phagocytic activity of either control or splenectomized animals.Splenectomy in the adult rat did not induce a phagocytic defect in the PAM and thus the lavageable PAM cannot be considered a significant site of the postsplenectomy defect. SinceC. parvumprotects animals from respiratory challenge withStreptococcus pneumoniaebut does not alter the number or activity of lavageable alveolar macrophages, we hypothesize thatC. parvumprotection is more likely related to our previous finding of an increased clearance of blood-borne bacteria by the expanded and enhanced reticuloendothelial system.

ISSN:0022-5282    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

SUMMARYPharmacologic alterations of the inflammatory response and collagen metabolism will lead to control of the many disease states of fibrosis. Many of these diseases kill and cripple far more than hypertrophic scar. Far too little research is being directed in this area. The objectives of controlling fibrosis by interfering with collagen crosslinking were defined clearly by Peacock. Perhaps topical BAPN will be the first agent to bring a practical clinical reality to his predictions made over 20 years ago.

ISSN:0022-5282    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The number of granulocytic stem cells (CFU-C) was measured in the peripheral blood of surviving and nonsurviving burned humans. It has been shown that the number of CFU-C in the peripheral blood of survivors increases over time and is elevated compared to the number found in normal humans. The number found in nonsurvivors, however, falls significantly in the later stages of burn injury, suggesting perhaps a defect in stem cell production and/or differentiation in patients with severe thermal injuries. The mechanism is unclear but its delineation may have an important bearing on understanding the nature of infectious complications following thermal injury.

ISSN:0022-5282    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Caloric requirements for spinal cord patients are not well understood. Energy expenditure was measured by indirect calorimetry and compared with predicted expenditure by manipulations of the Harris-Benedict (Long and Rutten), Quebbeman, and Spanier and Shizgal equations, using actual and ideal body weight: 45 measurements were made on 22 spinally injured patients, who were medically stable in their early rehabilitation phase of treatment, and included quadriplegics, paraplegics, and patients with Brown-Sequard syndrome. Other nutritional parameters were also followed. Equations based on normal patients consistently overestimated energy requirements of spinally injured patients.From the time of injury, spinally injured patients appear to have a reduction in their energy needs proportional to the amount of muscle which has been denervated. This decrease in caloric requirements continues throughout the rehabilitation and plateau phases. We have demonstrated that stable, rehabilitating spinally injured patients require 23.4 kcal/kg/day. As a group, quadriplegics required 22.7 kcal/kg/day, and paraplegics 27.9 kcal/kg/day. This represents only 45 to 90% of the recommended calories for maintenance as calculated by any of these recognized formulae, based on normal heights, weights, age, and sex, when using either current weight or ideal body weight.Spinally injured patients as a group are subjected to fluctuations in weight during treatment. Our own patients tended to become obese approximately 12 months after spinal cord injury on uncontrolled diets. All patients underwent an initial weight loss which was greater in the quadriplegics as a group, compared with paraplegics. On uncontrolled diets, our patients gained an average of 1.7 kg/wk and this was also greater in the quadriplegic group.

ISSN:0022-5282    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The esophageal obturator airway (EOA) has been approved for use in cardiopulmonary resuscitation (CPR) since 1973. Complications reported with its use include esophageal rupture, aspiration, and inadvertent tracheal occlusion or intubation with the obturator. Five cases of unrecognized tracheal intubation occurring in 170 cases of EOA use during CPR are reported. Records were analyzed for extent and treatment of injuries in the field and the hospital, blood gas levels before and after replacement of the erroneously placed EOA with an endotracheal tube (ETT), and outcome. Blood gas analysis confirmed absent ventilation and profound acidosis following tracheal intubation with the EOA with average EOA arterial blood gases: pH 6.9/pCO278/pO247. Mortality from this complication was 100%. Tracheal intubation with the EOA is under-recognized and under-reported. It is a potentially lethal complication. The EOA should be replaced with standard bag mask technique or preferably endotracheal intubation in the field by emergency medical technicians.

ISSN:0022-5282    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The metabolic effects of TPN containing high amounts of amino acids (18 gm N) was evaluated with respect to sulfur amino acid metabolism and protein breakdown in nine severely burned patients. The results were compared to corresponding data from burned patients receiving more moderate amounts of amino acids (9.2 gm N) or isocaloric amounts of carbohydrate and fat.Significantly increased urinary excretion and intracellular muscle tissue concentrations of methionine were found in patients receiving the concentrated amino acid solution, probably reflecting a combined effect of the injury and an increased load of the compound. These patients also showed a reduced oxidation of sulfur amino acids to inorganic sulfate, which may reflect an increased protein synthesis during treatment. A significantly decreased urinary excretion of 3-methyl-histidine and mercaptolactate was found in patients receiving the concentrated amino acid solution, probably reflecting a decreased breakdown of body protein. The findings favor the hypothesis of an anabolic effect of the new amino acid solution in burned patients during the early catabolic phase, but also emphasize the importance of monitoring the amounts of amino acids, e.g., methionine, given.

ISSN:0022-5282    

出版商:OVID    

年代:1985

数据来源: OVID