摘要:

Previous reports from this hospital documented a splenic preservation rate of 50% (18/36) in adults after blunt and penetrating traum. Recently (January through December 1984), use of an absorbable mesh helped to attain a 67% (22/33) salvage rate. The mesh is applied in such a fashion that it acts by tamponade. It proved useful in patients with bleeding from a large surface area or from deep parenchymal injuries, even those extending into the hilum.No deaths occurred in the splenic salvage patients. There was no difference in postoperative complications among the splenectomy, conventional splenorraphy, or mesh wrap splenorraphy groups. However, workup of persistent postoperative fevers in two splenic wrap patients revealed perisplenic fluid collections on CT scan. Aspiration yielded sterile fluid. Possible cause and effect relationship is being studied in the dog lab.We conclude that splenic wrapping is both a safe and efficacious method of splenic preservation.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Three hundred eighty-eight of 7,283 (5.3%) admitted trauma patients underwent urgent thoracotomy. In 61 patients (15.7%), pulmonary or tracheobronchial injury prompted thoracotomy (11, blunt; 50, penetrating).Pulmonary hemorrhage necessitated thoracotomy in 54 patients (88.5%); tracheobronchial injury in five patients (8.2%). The mortality was 27.9%. Nine patients (14.8%) underwent pneumonectomy: eight died of intractable hemorrhagic shock during thoracotomy despite rapid control of pulmonary hemorrhage: one died of sepsis. Eleven patients (18.0%) underwent lobectomy: six (54.5%) died of concomitant injuries. Thirty-six patients (59.0%) underwent pneumonorrhaphy: one died of concomitant injuries. Five (8.2%) patients underwent tracheobronchial repair: one died of concomitant injuries.Pneumonectomy was uniformly fatal and should be a procedure of last resort in the treatment of pulmonary injury, as lobectomy and pneumonorrhaphy are better tolerated by these critically ill patients.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This study was designed to delineate the factors that influence the extent and rate of recovery as related to the characteristics and duration of functional limitations resulting from trauma. The study population was 597 surviving trauma patients aged 16—5 years from two trauma centers in a single state system which follow similar care protocols, and included patients with extremity, abdomen, thorax, brain, and spinal cord injuries. Of 479 trauma patients (80% of the total) who were followed for a full year, 577c had no activity restrictions, 16% had some limitation with either a major or minor physical activity, but did not have any difficulty with mobility or self care, and 27% were limited in either mobility or one of the five basic self-care activities. Further analyses show that of the 262 individuals who were working full-time before the injury, 57% had actually returned to full-time employment within the year. Factors in addition to type and severity of trauma that influence return to work were higher educational level, white collar employment, higher preinjury income, and the presence of supportive individuals among family or friends. Recovery as defined by functional status and return to full-time work is analyzed by body region and severity of the principal injury sustained.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We reviewed 144 consecutive patients with flail chest and/or pulmonary contusion between 1979 and 1984. The purpose was to analyze the factors adversely affecting morbidity and mortality. There were 97 males and 47 females, with an average age of 40 years ± 18 S.D. (range, 2-83). Seventy-five per cent of the injuries were caused by motor vehicle accidents, with the remainder due to falls (17%), cardiopulmonary resuscitation (4%), altercations (2%), or falling objects (2%). The Injury Severity Score (ISS) averaged 32 ± 14 S.D. in all survivors versus 60 ± 14 S.D. in those who died. Eighty-three patients (58%) required mechanical ventilation. Thirty-six patients died (25%). Isolated pulmonary contusion or flail chest had a mortality of 16% each. However, the mortality more than doubled when there was a combined pulmonary contusion and flail chest (42%). More than half of all deaths were directly attributed to central nervous system injuries with another third due to massive hemorrhage. Factors that were associated with a higher morbidity and mortality included severe associated thoracic injuries, a high ISS, the presence of shock, falls from heights, and the combination of pulmonary contusion and flail chest.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

12). Based on this analysis, a set of triage guidelines was developed. The application of these guidelines to the study population indicated an undertriage rate of 4.1 to 6.3% and an overtriage rate of 16.8 to 21.3%, depending on the definition of major trauma.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Microcirculatory derangements in skeletal muscle could act to change cardiac output during endotoxemia. To explore this idea, we measured arteriole and venule responses to low-dose and high-dose endotoxemia in the rat cremaster muscle by direct in vivo videomicroscopy. Our data indicate that cardiac output increased in the low-dose group and decreased in the high-dose group. In both animal groups, a differential arteriolar response occurred to give small arteriole dilation and large arteriole constriction while venous diameters did not change. We conclude that: 1) changes in cardiac output during endotoxemia are not related to microvascular responses in skeletal muscle, and 2) the microvascular responses in skeletal muscle could be responsible for the decreased systemic vascular resistance during high cardiac output endotoxemia, but not for the elevated systemic vascular resistance during low cardiac output endotoxemia.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

From 1981 through 1985, 220 consecutive patients with presumed vascular injuries in the lower extremities underwent operation at the Ben Taub General Hospital. More than 81% of injuries were due to penetrating wounds, and blunt and iatrogenic injuries accounted for the remainder. A preoperative emergency center arteriogram was performed in 63.2% of patients, and physical examination alone prompted operation in 36.8%. Eight patients underwent immediate amputation; the remaining 212 patients were found to have 225 arterial (63.9%) and 127 venous (36.1%) injuries. More than 50% of patients were noted to have both arterial and venous injuries. Arterial repair was most commonly accomplished by segmental resection with an end-to-end anastomosis (28.4%) or insertion of a graft (38.8%). Venous repair was most commonly accomplished by lateral venorrhaphy (48.8%), ligation (19.7%), or insertion of a conduit (18.1%). Postoperative infection in closed wounds, in wounds left open because of the magnitude of injury, and in adjacent fractured bone occurred in 13% of patients. Late amputations were necessary in only four patients, three of whom had infection as the cause.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

During this study, 25 patients (26 limbs) incurred 37 vascular injuries to the lower extremity. The majority were young males injured by penetrating trauma (84%). There were 25 arterial and 12 venous injuries (two isolated). Sixteen patients had soft-tissue injuries, 12 had fractures, and six had peroneal nerve damage.Twenty-two arterial injuries were repaired, the majority (17) by saphenous vein bypass. Three tibial vessels were ligated. All major venous injuries were repaired. No synthetic material was used. Vascular repair took precedence in all but two cases. After repair, the vascular surgeon assisted with stabilization. Thirteen limbs required fasciotomy; nine required subsequent debridements and later plastic reconstruction.Limb salvage was 96%. More important, 21 patients can ambulate independently on the injured extremity (84%). These results support an aggressive approach to lower extremity vascular trauma with repair of all major arterial and venous injuries in conjunction with aggressive debridement and soft-tissue repair.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This study reviewed all 164 cases of liver trauma seen at the Charity Hospital of New Orleans from 1980 through 1984, in 12 of whom intra-abdominal abscesses formed. Thirty four per cent of the patients had no peritoneal drainage and an abscess rate of 1.8%, 18% had only closed suction drainage and 0% abscess rate, 15% had only open sump drainage and a rate of 8.3%, 14% had only open Penrose drainage with a rate of 8.7%, and 19% had a combination of both open Penrose and sump drainage with a rate of 22.5% Certain findings or conditions were related to the development of postoperative sepsis. Gunshot wounds were associated with a 9.9% abscess rate, blunt trauma with 3.8%, and stabbings with 0%. Patients who presented in shock were at a threefold increased risk for intra-abdominal abscess formation, those who needed blood transfusions of greater than 6 units were at a tenfold increased risk, those with major liver injuries were at a sixfold increased risk, and those with a total of three or more abdominal organs injured were at a threefold increased risk for abscess formation. There was no significant relation between presence of gastrointestinal perforation and subsequent abscess formation. For patients without the specific risk factors mentioned above, the probability of developing an intra-abdominal abscess is low. This group of patients would therefore benefit little from the presence of a drain, but might very well be harmed by the introduction of external contaminant bacteria into the peritoneal cavity by the drain itself. However, in the presence of the above risk factors, the safer method of management would be the employment of closed suction drainage, as this method offers the benefit of removal of fluid accumulations of blood and bile, while being associated with the least risk of external peritoneal contamination.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Cats were subjected to a 3.5-atm fluid percussion impact administered to the cerebral cortex. Near-infrared spectrophotometry (NIRS) was used to measure the quantity of oxyhemoglobin and total hemoglobin in the illuminated tissue as well as the cytochrome a, a3redox state. Corroborative data were obtained by freezing brains with liquid nitrogen and measuring cortical concentrations of ATP, creatine phosphate (CP), and lactate. Immediately postimpact there was a rise in mean arterial pressure with a 38% increase of highly oxygenated blood and a shift toward oxidation in the cytochrome a, a3redox state. By 4 hours postimpact, cytochrome a, a3was becoming progressively reduced despite the persistence of hyperemia. This was associated with a significant (p<0.01) decrease in ATP and CP concentration. Additional studies in which a 0.5-sec, 100-v electrical seizure was induced before and after fluid percussion demonstrated significant differences in seizure response, indicating a failure of autoregulation.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID