摘要:

Blunt injury to the heart ranges from contusion to disruption. This report comprises 14 patients seen during a 6-year period with cardiac rupture secondary to blunt trauma. Eight patients were injured in automobile accidents, two patients were injured in auto-pedestrian accidents, two were kicked in the chest by ungulates, and two sustained falls. Cardiac tamponade was suspected in ten patients. Five patients presented with prehospital cardiac arrest or arrested shortly after arrival. All underwent emergency department thoracotomy without survival. Two patients expired in the operating room during attempted cardiac repair; both had significant extracardiac injury. Seven patients survived, three had right atrial injuries, three had right ventricular injuries, and one had a left atrial injury. Cardiopulmonary bypass was not required for repair of the surviving patients. There were no significant complications from the cardiac repair.The history of significant force dispersed over a relatively small area of the precordium as in a kicking injury from an animal or steering wheel impact should alert the physician to possible cardiac rupture. Cardiac rupture should be considered in patients who present with signs of cardiac tamponade or persistent thoracic bleeding after blunt trauma.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Major injuries to the testicles, penis, and genital skin from trauma and infection were seen in 62 patients over a 6-year period (1977 to 1983). Urethal injuries were excluded. In the past blunt testicle injuries were infrequently diagnosed and surgically ignored because of large surrounding hematomas. With the use of real-time ultrasound, 17 of 18 cases of testicle rupture were correctly diagnosed preoperatively. Surgical repair resulted in testicle salvage in 16 patients. Penetrating testicle injuries resulted in a high orchiectomy rate secondary to the infrequently described but recognized entity of self-emasculation in transsexuals. Penile rupture from blunt injuries (8) was successfully repaired and complete function was recovered. Penetrating penile injuries (4) were extensive and involved the urethra in two cases; full function returned after reconstruction. Major skin loss of the penis and/or scrotum (19) occurred from necrotizing fascitis, burns, avulsion and penetrating injuries. Early debridement, bowel and urinary diversion followed by penile skin grafting, thigh pouches to protect testicles, and scrotal reconstruction resulted in acceptable cosmetic and functional results in all cases of major skin loss.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Twenty-seven patients with post-traumatic abscesses treated by percutaneous drainage using radiologic localization and guidance were reviewed. Twenty-six patients were successfully drained and operation was avoided in twenty-one.Our results, which parallel those previously reported, indicate that radiologic drainage is safe and effective. Associated with lower rates of mortality, morbidity, and recurrence, it should be attempted before surgical reexploration in most situations after diagnostic procedures have demonstrated an accessible collection.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

To determine the best antibiotic regimen to employ in patients undergoing laparotomy for trauma, a randomized prospective study was designed comparing cefoxitin alone with a triple-drug regime of an aminoglycoside, ampicillin, and clindamycin.One hundred nineteen consecutive patients sustaining abdominal trauma (97 penetrating; 22 blunt) were divided by date of admission to a 24-hour course of antibiotics.The overall infection rate was 16.0%, with 14.5% of the cefoxitin-treated patients, and 18.0% of the triple-drug-treated patients developing an infectious complication. Excluding remote site infections, the abdominal wound and intraperitoneal infection rates were 13.0% for cefoxitin-treated patients, and 12.0% for triple-drug-treated patients. There was one instance of oliguric renal failure questionably related to an aminoglycoside.It is concluded that a 24-hour course of cefoxitin is a safe and effective prophylactic antibiotic regime in patients undergoing laparotomy for trauma.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Within 24 hours after a full-thickness burn injury, predictable alterations occur in the dermal vasculature. At the immediate site of injury, vessels lose patency. In the periphery, vasodilation and increased permeability become widespread. A variety of interventions were employed to prevent these vascular sequelae. While systemic treatment, immediately after burn trauma, with hydrocortisone or the non-steroidal anti-inflammatory compound indomethacin, was ineffective in preventing vascular alteration, treatments with other NSAI agents such as ibuprofen and imidazole were effective in preventing microvascular occlusion. In addition, utilizing standard radioimmunoassay techniques, the concentrations of the metabolites of two potent eicosanoids, thromboxane and prostacyclin, were measured from fluid collected in the implanted wound chambers. Following full-thickness burns, the synthesis and release of thromboxane were inhibited by indomethacin, imidazole, and ibuprofen. Furthermore, indomethacin and ibuprofen, but not imidazole, blocked the synthesis and release of prostacyclin into wound fluid. Significantly, ibuprofen was effective in preserving the dermal vasculature, even when administration was delayed as long as 6 hours after burn trauma. Pharmacologic actions not associated with the production of thromboxane or prostacyclin appear responsible for the protective effects of ibuprofen during burn injury. Such findings do not support an important role for either thromboxane or prostacyclin in the development of vascular alterations following burn injury.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

To further characterize immunologic alterations found in thermally injured patients, a series of experiments dealing with lymphocyte immunoglobulin production were performed. Circulating immunoglobulin levels were measured, plasma antitetanus toxoid was quantitated, and lymphocytes were cultured and in vitro immunoglobulin production recorded. Postburn circulating immunoglobulins were initially depressed but returned to normal at a variable rate. We found a normal response to rechallenge with tetanus toxoid. However, culture of lymphocytes in vitro showed that lymphocytes from burned patients had an elevated spontaneous immunoglobulin production and no augmentation with mitogen stimulation. This alteration in immunoglobulin production was not found in a group of postoperative or trauma patients and appears to be unique to burned patients.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A model of experimental post-traumatic osteomyelitis is described in which the femur of guinea pigs was fractured and infected withE. coli(105) orStaphylococcus aureus(104). Traumatized uninfected animals served as controls. The animals were further divided within each group by treating the fractured site with an intramedullary wire in one half. Osteomyelitis developed and became chronic in all guinea pigs infected withStaph. aureus,and in nine of 12 infected withE. coli.All animals infected withE. colitreated with an intramedullary wire developed chronic osteomyelitis; only four of seven fromE. coli-infected animals with fractures developed this disease. Moreover,Staph. aureuscould be recovered from the osseous tissue in the chronic stage of the disease regularly, whileE. coliwas only present in the early weeks after operation, but not in the chronic stage.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The present study was undertaken to determine the safety of type-specific uncrossmatched blood transfusions for severely hypovolemic trauma patients. During a 3-year period 875 units of type-specific uncrossmatched blood were given to 160 severely hypovolemic trauma patients who could not be adequately resuscitated with crystalloid solutions. No transfusion reactions resulted from the administration of type-specific uncrossmatched blood. Subsequent major crossmatch failed to identify either blood incompatibility or significant antibodies.Type-specific uncrossmatched blood is safe and is a rapidly available alternative to crossmatched blood in the severely hypovolemic trauma patient.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Zinc metabolism and turnover were studied after oral65Zn given to 1-year-old rats before acute fracture trauma, after which calcium balance was decreased but still positive, while that of zinc was highly negative due to early increased intestinal excretion and late increased urinary excretion. Decreased serum calcium was related to increased urinary excretion while serum zinc initially seemed to be lowered by a metallothionein-mediated flux into the liver. The intestinal and late urinary losses of zinc would greatly affect the body stores of zinc. The specific activity of65Zn and the zinc accretion rate were increased in intact rat skeletons. A similar but not so extensive reaction of intact control rats in this study indicates a liability in the homeostasis of zinc for adult rats.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Fifteen cases of gunshot wounds of the esophagus seen between the years 1970 and 1978 were reviewed, eight involving the cervical esophagus and seven involving the thoracic portion. Most common symptoms were pain, neck tenderness, dyspnea, and dysphagia. Signs observed were subcutaneous emphysema, crepitations, fever, and leukocytosis. Plain X-rays showed pneumomediastinum, hydrothorax, and pneumothorax. Perforations were confirmed by barium studies in 12 patients. Injuries in the cervical portion were treated by prompt exploration, closure of the defect, and drainage. There were no deaths in this group. Thoracic injuries were treated by prompt thoracotomy except in one patient, for whom the diagnosis was not made until 22 hours after the injury; his was the only death in this series. Because of the extensive tissue involvement in gunshot wounds, primary repairs of thoracic esophageal perforations have a high incidence of failure. Defunctionalization of the esophagus, through ligation of the distal esophagus, gastrostomy, and cervical esophagostomy, has provided a safer method. Use of a double strand of absorbable Dexon to ligate the distal esophagus made a second thoracotomy for removal of the ligature unnecessary. We have adopted routine use of hyperalimentation, avoiding the need for feeding jejunostomy.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID