摘要:

The technique for treating nonunion of the tibia by means of electricity delivered to the site by percutaneously inserted electrodes is described. Of 131 tibial nonunions so treated with constant direct current for 12 weeks, 107 (81.7%) achieved solid bony union. Analysis of the 24 failures in the series indicated that eight of the patients did not receive adequate electricity. Of the 123 patients who did receive adequate electrical treatment (four cathodes each delivering 20 microamperes continuously for 12 weeks), 107 (87%) achieved bony union. The presence of previous osteomyelitis at the fracture site or the presence of previously inserted metallic fixation devices did not effect the end result heal rate. Comparison of the rate of union reported in this study to rates of union reported in the literature for bone graft surgery reveal no statistically significant differences in the results achieved by the two methods. Since the risk/benefit ratio is lower for direct current treatment of nonunion than that associated with conventional bone graft surgery, it is concluded that the electrical treatment of nonunion promises to become the preferred method of treatment for that condition.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

In 1979 the A.A.S.T. continued presentation of several panel discussions. We are pleased to publish herewith the panel “Current Status of Emergency Medical Services,” given in September 1979 and moderated by Doctor Donald S. Gann.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

One hundred patients with replantation or revascularization of 149 hand units were studied with respect to return of function. Criteria for assessment included level and mechanism of injury, age, active range of motion, two-point discrimination sensibility ratings, grip and pinch strength, cold intolerance, and return to previous employment. Survival rate for replantation was 79% and for revascularization 97%. In the 38 replantation patients 80% underwent secondary operations, the most common being flexor tendon reconstruction. Most digits regained two-point discrimination of better than 10 mm; normal two-point discrimination was achieved in 40% of digits in this group; total active motion of 84% of fingers was rated poor. In the 62 revascularizations motion of 28% was rated poor, of 29% rated excellent.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Pulmonary effects, lung clearance, and tissue retention of blood-bornePseudomonas aeruginosawere compared in dogs (n= 5) and pigs (n= 5) during continuous 6-hour intravenous infusion of 1.2(109) bacteria/min/20 kg. Control pigs received an equal volume of sterile saline. In contrast to controls, experimental pigs developed pulmonary artery (PA) hypertension (mean, 30 ± SE 3; baseline, 17 mm Hg) and pulmonary failure manifested by hypoxemia (mean Pao2, 49 ± 4; baseline, 78 ± 2 mm Hg;p< 0.001), increased intrapulmonary shunting (40 to 50%), noncardiogenic pulmonary edema, and congestive atelectasis, a pattern of pulmonary failure very similar to sepsis-induced ARDS in humans. In dogs, PA pressures were unchanged from baseline, no edema was detected, and comparable hyperventilation was associated with an increase in Pao2from 77 ± 4 (baseline) to 87 ± 2 mm Hg (p< 0.001). Tissue retention of viable blood-borne organisms in pigs was greatest in the lungs. In dogs, lung retention was minimal and greatest tissue retention occurred in the liver and spleen. We conclude that both lung clearance of blood-borne organisms and bacteremia-induced pulmonary failure are quite host dependent.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The present investigation was undertaken to standardize the early diagnosis of Gram-negative septicemia in burned children. Data were collected by means of a matrix which encompassed eight clinical variables rountinely monitored by nursing personnel. These variables were evaluated according to their severity using a numerical scale of 0 to 3. A sepsis score was thus calculated for each of 243 burned patients, three times a day throughout their entire hospitalization. Eighty patients with suspiciously high scores (controls) were subjected to a battery of ten laboratory tests aimed at confirming the presence or absence of septicemia.During the 26 months of the study 16 patients (22 episodes) had clinical and laboratory evidence of Gram-negative septicemia. Multiple regression and discriminant analysis techniques were then used to develop statistical models for early diagnosis of septicemia. The two most practical and reliable of these are reported herein. Model I and II would have predicted the diagnosis of sepsis, 83% and 86% of the time, respectively, 1 day before the diagnosis was made using conventional methods. The false positive rates of Models I and II were 7% and 3%, respectively.On the basis of this information it seems possible and rewarding to utilize decision-making charts for monitoring and diagnosis of septicemia.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Amino acids and dextrose infusion were given for short periods of time to a young man whose basal state is characterized in the previous paper in this series, and their effects were documented in terms of plasma concentrations and splanchnic extraction. The basal state measurements show in the acute trauma state and its subsequent starvation state a largely balanced splanchnic extraction of amino acids but at a decreasing rate. Amino acid (FreAmine) infusion at low rates on this background produced a large increase in extraction of a largely balanced mixture of amino acids but a minimal change in glucose release. The septic state is characterized in both the basal and amino acid infusion state by splanchnic extraction of an unbalanced mixture of amino acids which is deficient in branched-chain amino acids and in relative excess of glucogenic amino acids with increased glucose release and increased utilization of amino acids for gluconeogenesis. In early sepsis this state can largely be repaired by exogenous amino acid infusion but in late sepsis can only be partially repaired. The data suggest that the patient in late sepsis should have a branched-chain rich amino acid mixture and that the hepatic failure of sepsis is strongly associated with peripheral release of an unbalanced mixture of amino acids secondary to enhanced branched-chain catabolism. Infused glucose produces a large increase in the plasma glucose but also improves the balance of the splanchnic amino acids extracted.The statistical validity of the preceding statements are examined in detail in the manuscript.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Candidaorganisms were cultured from 452 of 1,513 hospitalized burned patients during a 6-year study period. Of the 172 patients with colonization of the eschar by this fungus, only 20.7% subsequently developed invasive candidal sepsis. The mortality of untreatedCandidaburn wound infection was 100%f, and with aggressive medieal-surgieal therapy, 91.6%. Candidemia was present in 52 patients and 76.9% of these died.Candidainfection was seen as a preterminal phenomenon, coincident with a generalized collapse of patients' defensive and homeostatic mechanisms. For this reason, mortality was high and the infection rarely rosponded to treatment.Control of this lethal complication rests with prevention by the judicious use of intravenous broad-spectrum antibiotics and expeditious closure of the burn wound.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

A 31-year-old male who sustained completely penetrating impalement wounds of the head and chest by reinforced steel bars in a fall at a ferroconcrete building construction with a miraculous survival is reported. The bars were successfully removed; a surgical mallet was required to loosen the bar impacted in the patient's head. After 12 days he was discharged, and he has returned to construction work and is well 3 years postinjury.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

An unusual case of traumatic urethro-cavernous fistula from the fall of a heavy object upon the flaccid penis is described. In the absence of clinical evidence of urinary extravasation, prompt performance of corpus cavernosography helped detect the existence of such a fistulous communieation. Institution of prompt suprapubic urinary diversion avoided occurrence of undesirable sequelae to intracorporeal urinary leak and ensured uncomplicated spontaneous closure of the fistula.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Recurrent episodes of abdominal pain, nausea, and vomiting associated with hyperamylasemia were noted in a 27-year-old female following blunt trauma in a bicycle accident. Ultrasound study of the upper abdomen and an upper gastrointestinal series were normal. Endoscopic retrograde pancreatography (ERP) demonstrated a disruption of the main pancreatic duet and was very useful in planning and performing a distal pancreatectomy 17 days postinjury. The patient continues to be well 3 years later.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID