摘要:

Using computerized gamma scintigraphy, 10-cm H2O PEEP did not alter the rate of capillary protein leakage in dogs following pulmonary microvascular injury with 0.01 to 0.2 ml/kg oleic acid. A rising lung:heart radioactivity ratio, or ‘slope of injury,’ was seen during PEEP which paralleled the ‘slope of injury’ had PEEP not been used. A sudden decrease in lung and heart count activity (p< 0.001) and decreased lung:heart radioactivity ratio (p< 0.001) occurred with PEEP at all doses of oleic acid studied. An apparent improvement in the standard chest roentgenogram was seen within 2 minutes following PEEP in dogs given 0.2 ml/kg oleic acid. However, progression of the radiographic infiltrate occurred in these animals during 30 minutes of PEEP. When all vessels leading to and from the heart and lungs were ligated, PEEP produced a 60% fall in count activity over the lung without any change in cardiac radioactivity. The apparent radiographic improvement and 2/3 of the fall in lung radioactivity with PEEP were due to an increased pulmonary air volume and 1/3 due to a decreased pulmonary blood volume. The decreased cardiac output with PEEP must be secondary to decreased ventricular filling rather than decreased ventricular function.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

We studied the incidence of infection in lacerations in a controlled, double-blind, Armitage sequential clinical trial. After standard prescribed preparation of the wound area, and immediately before suture, each laceration was flooded with the 10 ml content of a numbered, amber glass vial. Half of the vials contained a solution of 0.9% NaCl; half contained a 5% solution of sodium benzyl penicillin. No other factors were controlled. A single observer made the determinations of presence or absence of infection, purulent or nonpurulent, early and late after suture. After study of 260 lacerations the study indicated a clear superiority of penicillin over saline in lowering the incidence of infection with a statistical significance ofp< 0.00005. In a sample of this size the 95% confidence limits of the magnitude of the superiority of penicillin cover a wide range, but it appears that two out of three or three out of four infections can be averted merely by flooding the wound with penicillin immediately before suture.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Passive leg raising is widely used to treat hypotension associated with hypovolemia. Presumably gravity causes a central translocation of leg venous blood and an increase in filling pressure, cardiac output, and arterial pressure. Ten healthy volunteers, 25 to 35 years old, had measurements of heart rate, blood pressure, and cardiac output in the supine position after 20 sec and 7 min of 60° passive leg elevation. The protocol was performed 3 and 45 min after the subjects changed from an ambulatory upright to a supine position. Stroke volume and cardiac output increased transiently (8–10%) when the legs were raised after 3 min rest in the supine position. By 7 min of leg elevation, these beneficial effects disappeared. After 45 min supine, leg raising had no effect on stroke volume or cardiac output but increased blood pressure (4 mm Hg) by increasing peripheral resistance (15%). Thus, leg raising, like application of the MAST trousers, fails to produce any sustained increase in cardiac output or stroke volume. Small venous leg volumes and time-dependent changes in the distribution of venous volume and compliance may explain the absence of any sustained 'autotransfusion' effect.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Lipid mobilization following thermal injury was studied in 25 patients with burns of between 35 and 95% TBSA for 30 to 50 days postinjury. The concentration of free fatty acids and glycerol in the plasma was elevated. The concentration of plasma triglycerides was elevated, while the concentration of ketone bodies remained normal. Thus it is suggested that the free fatty acids are primarily being re-esterified to triglycerides rather than being utilized for ketone body production.During the first 10 days postinjury, the plasma carnitine level was slightly decreased, while the concentration of carnitine in liver and muscle was elevated. The level of carnitine in burn wound fluid was similar to that in plasma. Therefore, the early decrease in plasma carnitine appeared to result from wound losses, as well as the sustained increased uptake by liver and muscle throughout the burn course.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Neutrophil chemotaxis was studied sequentially in 23 thermally injured patients and 23 normal volunteers. The average age of the burn victims was 48 years (range, 21–87) and mean total body surface area burned was 33% with a mean full-thickness component of 16%. Chemotaxis was measured under agarose since this test system allowed the chemotactic generating ability of the patients' serum to be evaluated as well as the chemotactic capability of the neutrophils. In excess of 800 determinations were performed on the burned patient population. Eighty-three per cent of the patient population had a decrease in chemotaxis two standard deviations below normal at some time during the hospital stay, in most patients three or more days postburn. This chemotactic defect appeared to be unrelated to the presence of a chemotactic factor inactivator. There was no statistically significant correlation between the development of abnormal chemotaxis and sepsis or mortality in this patient population.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Valgus closed reduction and internal fixation with a 150° nail-plate produced favorable results in 55 stable and 45 unstable intertrochanteric fractures. The average axial collapse (impaction) was 14.9 nun in stable fractures and 19.6 mm in unstable fractures. Most (65%) of this spontaneous impaction occurred within the first week. There were six (6.0%) failures of fixation. The two failures (3.6%) among the stable fractures were the result of malpositioning of the internal fixation device. Four (8.8%) unstable fractures demonstrated loss of fixation related to failure to allow sufficient slide within the nail to accommodate the postoperative axial collapse of the fracture fragments. It is recommended that 20 to 25 mm of nail slide be made available in stable fractures and 25 to 30 mm in unstable fractures. This will increase stability by allowing the sliding nail to accommodate the complete post-fixation axial collapse of the fracture fragments.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

In August 1980 a terrorist bomb attack was made on the central railway station of Bologna, Italy. Altogether 291 persons were injured, 73 of whom died at the scene. An analysis of the nature of the injuries and the mechanism by which they occurred showed that three types of bomb injuries could be distinguished: primary blast injuries (pulmonary injuries and flashburns), and secondary and tertiary injuries (concussions, lacerations, and fractures), the latter two types from flying debris set in motion by the blast wave or propulsion of the body. Chest X-ray should be included as a routine part of the examination of blast-injured patients on admission, since many of them develop respiratory insufficiency within 24 hours even when primary symptoms are mild. Because the secondary and tertiary effects of a bomb explosion often lead to multiple injuries, these patients require considerable therapeutic and medical care resources. By an evaluation of the degree of severity of the injuries with use of the AIS (Abbreviated Injury Scale) and ISS (Injury Severity Score) systems, the injurious effects of different types of disasters can be estimated and the findings can serve as a basis for future planning of disaster preparedness.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

From 1973 through 1980 144 patients with chest trauma were treated. Concomitant acute respiratory failure was considered severe in 125 (83%). Morbidity and mortality were found to be related to the presence of shock, head injury Glasgow score 3–4, and size of the flail segment, but not by the extent of the thoracic or intrathoracic injuries. Mortality for the whole group and for the flail chest group were 8.3 and 9.5%, respectively.Treatment was analyzed in two historical periods: In the first, 1973 through 1976, controlled mandatory ventilation and tracheostomy were used in 83 and 70% of the cases, respectively. In the second period, 1977 through 1980, intermittent mandatory ventilation plus soft-cuff endotracheal tube were used in 77% of the cases. Ventilator time did not vary in these two periods but the lung oxygen transport was better in the group treated with intermittent mandatory ventilation.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Computerized tomography (CT) can be a useful adjunct to conventional radiography in assessment of acetabular fractures and fracture-dislocations of the hip. Owing to the complex bony architecture of the acetabulum, CT affords better definition of fracture patterns in this region than roentgenography, including special views and tomography. The cross-sectional views of CT offer improved definition of the characteristics of a complex acetabular fracture, including integrity of the weight-bearing dome, congruity of joint surfaces, degree of comminution, size and spatial relationship of fragments, and presence of intra-articular fragments. Computerized reconstruction of sagittal and coronal views at desired levels duplicates polytomography and renders standard tomography unnecessary. Radiation exposure required for a CT examination of the pelvis is equal to or less than that required for a polytomography study. CT can be utilized as a valuable diagnostic aid in the assessment of selected acetabular fractures and fracture-dislocations of the hip, providing often otherwise unobtainable information to the choice of treatment for these difficult injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID