摘要:

Destruction of the blood supply to tendons adversely affects healing of repaired flexor tendons. In cut and sutured avian flexor profundus tendons, protein synthesis was maximal on Day 10 post-trauma with a broad peak that spanned at least 12 days. Partial devascularization of cut-sutured tendons reduced protein synthesis to 43% of the value for nondevascularized-cut-sutured tendons on Day 10. Both collagen and noncollagen protein synthesis in cut-sutured tendons followed a bimodal pattern with peaks on postoperative Days 10 and 18. Collagen and noncollagen protein synthesis in partially devascularized tendons was decreased. Relative collagen synthesis, that is, the amount of collagen produced compared with the amount of all other proteins produced at the same time, was increased (Days 10 to 15) in the tendons that were cut-sutured and partially devascularized. The latter observations indicate that: 1) cutting a tendon results in increased protein synthesis; 2) partial devascularization of the cut tendon results in a lesser increase in protein synthesis; and 3) although overall protein synthesis, and collagen synthesis in particular, are reduced in partially devascularized, healing tendons, the relative amount of collagen produced is increased, emphasizing the importance of collagen to the healing tendon during the time of maximum synthesis.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The increase of plasma ketone bodies (acetoacetic acid and β-hydroxybutyric acid) is related to the efficient protein-sparing adaptation during a total fast by healthy man. This study investigated the response to a total fast during the postinjury state. Twenty patients with skeletal or soft-tissue trauma received 3 days of carbohydrate-free intake and then 3 more days of carbohydrate intake. Control subjects were ten postoperative patients and two healthy volunteers who received similar nutritional treatment. The trauma patients lost nearly 20 gm of nitrogen/day, which was twice control, and had a resting energy expenditure of 27.07 kcal/kg, 21.4% greater than controls. Trauma was found related to an elevation in plasma glucose and to inhibit the rise in plasma ketone bodies and free fatty acids. In contrast, indirect calorimetry showed that fat contributed 63% of the nonprotein energy on the third day of fasting and injury. These data indicate that fat is utilized by the trauma patient but that fat metabolism is abnormal compared to starvation in healthy or mildly stressed patients.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Computerized gamma scintigraphy was shown in this study to bc a sensitive technique for the detection and kinetic analysis of a pulmonary capillary protein leak. A rising lung:heart radioactivity ratio or ‘slope of injury’ was found at each dose of intravenous oleic acid in dogs from 0.01 to 0.20 ml/kg (p< 0.01). This ‘slope of injury’ was proportional to the dose of oleic acid (r= +0.97; p < 0.004) and was more sensitive than changes in arterial oxygen tension, standard chest radiography, bloodless wet:dry lung weight, or alveolar epithelial membrane permeability. Only standard light microscopy and right lymphatic duet flow were able to document the leakage of protein detected by gamma scintigraphy at 0.01 ml/kg oleic acid.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Malnutrition is associated with an increased susceptibility to infection by altering host defense mechanisms. A number of investigators have demonstrated restoration of in vitro immunocompetence following nutritional repletion with intravenous hyperalimentation. This study was designed to assess in vivo host defense mechanisms following protein depletion and repletion using a septic challenge.Female Fischer rats (150 gm) were fed a regular diet or a 2% agar protein depletion (DEP) diet for 14 days. The rats were then administered an infectious challenge with intraperitoneal injections of 7 ml/kg of a solution of 109organisms/ml ofE. coliwith 4 gm% hemoglobin as red cells. Two additional DEP groups were repleted by regular diet (DEP-Oral) or by an intravenous solution (DEP-TPN) of dextrose-amino acid-lipid (D253.75% Aminosyn, 10% Intralipid) for an additional 2-week period, and given the experimental peritonitis challenge.Normal rats challenged withE. coli-hemoglobin adjuvant peritonitis had 66% survival as opposed to 15% survival of protein depleted rats. Protein-depleted (DEP-Oral) rats refed with regular diets had a 60% survival which was comparable to normal controls. Rats repleted with intravenous hyperalimentation had a mortality comparable to protein-depleted controls.The data confirm that protein depletion is associated with loss of host defense mechanisms. Although refeeding by regular diet resulted in restoration of host defense, repletion by parenteral nutrition, in this model, did not improve survival.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Seven patients with cardiac rupture from blunt trauma were encountered at the University Hospital, University of Alabama School of Medicine, in a 15-year period. Five of seven patients survived, including three with left atrial injuries and one each with right ventricular and left ventricular injuries.Useful diagnostic features included systolic hypotension, distended neck veins, and elevated central venous pressures. Associated injuries averaged four per patient. Successful management demands a high index of suspicion of cardiac injury, prompt diagnosis, and immediate median sternotomy. After repair of the heart the incision should usually be extended to allow exploratory laparotomy.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Sincc April 1977, we have used splenorrhaphy as the procedure of choice for splenic trauma. To evaluate the efficacy of this procedure, we graded splenic injury based upon the extent of splenic repair in 77 patients with blunt abdominal trauma. This grading system is as follows: Grade 1—capsular injuries not actively bleeding at the time of laparotomy and not requiring treatment (five patients); Grade 2—capsular or parenchymal injuries requiring topical hemostatic agents (13 patients); Grade 3—parenchymal injuries requiring suture repair (nine patients); Grade 4—parenchymal injuries requiring partial splenic resection (seven patients); Grade 5—total splenic devascularization or uncontrollable bleeding from the splenic pedicle requiring splenectomy (43 patients). Twenty-nine patients had associated orthopedie injuries, and 42 patients had associated intra-abdominal or thoracic injuries. Mean operative time was 130 ± 10 minutes. Operative time increased with severity of associated intra-abdominal injuries. Mean operative transfusion requirement was 500 ± 100 cc of packed red blood cells. Transfusion requirements were not related to the severity of splenic injury. Twenty-three patients developed complications. Pancreatitis occurred in three patients, atelectasis or pneumonitis in eight patients, ten developed wound infections, and two patients required reoperation for small-bowel obstruction. Complication rates were not related to the degree of splenic injury.The grading system described herein provides a framework for sound clinical judgment and comparison of results in the management of splenic injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

In a survey study of septic trauma patients, the response of plasma amino acid concentration to albumin infusion was contrasted in survivors (14 patients) and nonsurvivors (11 patients). Plasma albumin levels were maintained at 3 gm/dl by albumin infusion (0–128 gm/day) because of central venous pressure/adequate circulation considerations.Survivors showed no significant increase in plasma essential amino acid concentration as a function of albumin infusion. In nonsurvivors threonine, valine, leucine, phenylalanine, lysine, and histidine all rose significantly (p ≤ 0.025) with albumin infusion. Isoleucine (8 residues/molecule albumin), in contrast to leucine (60 residues/molecule), did not increase. As a result, the ratio of isoleucine to leucine (Ile/Leu) decreased with albumin infusion from 0.47 (no albumin infused) to 0.27 (60 gm albumin/day). Survivors did not exhibit a similar response. The low Ile/Leu increased in most nonsurvivors with amino acid infusion from 0.27 (no amino acids) to 0.59 (150 gm amino acids/day).The data strongly suggest that nonsurvivors had an increased rate of albumin catabolism with subsequent amino acid release. Moreover, hypoalbuminemia treated with albumin infusion without amino acid infusion appears to produce a relative isoleucine deficiency which may detrimentally affect protein synthesis.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

A prospective study was undertaken to evaluate the utility of calculating transferrin from total iron-binding capacity in the nutritional assessment of burned patients. Regression analysis was used to compare total iron-binding capacity with radial immunodiffusion transferrin determinations. The method used for calculating transferrin (0.8 TIBC – 43) is a frequently published conversion formula for deriving transferrin. One hundred twenty-five data sets were obtained from 45 burned patients. Values for derived transferrin ranged from 39 to 235 mg/dl, averaging 121 mg/dl. Actual transferrin averaged 162 mg/dl, ranging from 41 to 320 mg/dl. Forty-eight actual serum transferrin samples were normal (greater than 172 mg/dl) whereas only 17 derived transferrin values were normal. While there is a correlation between total iron-binding capacity and serum transferrin (r = 0.85), to calculate transferrin according to the formula above would have resulted in significant error in the clinical assessment of the patients' nutritional status (p< 0.001). From our studies, the formula for conversion of total iron-binding capacity to transferrin was found to be (0.68 TIBC + 21). These results suggest that the development of a universal conversion factor is not feasible. Modification of the formula may be necessary at each institution if clinically useful evaluations of serum transferrins are to be derived from iron-binding capacity for use in nutritional assessment.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Dramatic advances in replantation and microsurgery have somewhat altered the criteria we use in selecting patients to be candidates for upper extremity replantation surgery. We suggest that contraindications for such replantation are: presence of associated life-threatening injuries; serious anesthetic risk; preexisting medical or psychiatric problems; previous injury or disease of the amputated part; warm ischemic time >6–8 hours for extremities or >10–12 hours for digits; and single-digit amputations (except thumb, for grasp). Replantation is feasible when: amputated part is properly preserved; injury type is sharp amputation, mild to moderate crush, or selected avulsion, and amputation is proximal to the DIP joint. Careful preservation of the amputated part, not in dry ice, is mandatory. On an individual basis, the decision to attempt replantation rests on the prediction that the patient may have better function with such surgery than with a prosthesis.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Previous studies have indicated that combining cerium nitrate with silver sulfadiazine (Silvadene, Marion Labs) yields a superior topical agent for the treatment of burns. Cerium nitrate in silver sulfadiazine was tested in a controlled study with silver sulfadiazine alone. The study population consisted of two groups of children suffering burns greater than 30% of the body surface. The patients ranged in age from 1 to 21 years. The study period was for the first 10 weeks of hospitalization. Quantitative surface cultures were used to monitor burn wound flora.No superiority for the silver sulfadiazine-cerium nitrate combination was demonstrated. In fact, cultures indicate a significantly greater percentage of Gram-negative pathogens in patients treated with the cerium mixture.Cerium nitrate could possibly prove of greatest benefit if used as a reserve therapy for colonizing organisms which do not routinely respond to silver sulfadiazine.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID