摘要:

Phagocytic and bactericidal assays showed that a close correlation was present between bactericidal activity and neutrophil chemiluminescence (PMN-CL) (r= 0.81;p< 0.01). This suggested that the microbicidal action of the neutrophil depends metabolically on the generation of oxygenating agents.PMN-CL and opsonic index (OI) were measured in 36 burned patients. The levels of serum transferrin (Tf) were examined simultaneously by nephelometric method in order to determine the correlation between humoral-phagocyte axis of immune system and nutritional status. It was found that PMN-CL and OI were generally lower in the greater than 35% TBSA burn group (PMN-CL, 1.85 ± 0.21 cpm × 103, OI, 0.69 ± 0.06) compared with control subjects (PMN-CL, 3.55 ± 0.15 cpm × 103, OI, 1.05 ± 0.04). It suggested that both neutrophil oxygenation activity and opsonic activity were impaired following severe burns.PMN-CL was higher in the smaller than 30% TBSA burn group during infection phase as compared with control subjects (5.61 ± 0.26 cpm × 103vs. 3.55 ± 01.5 cpm × 103p< 0.01). It remained high in patients with persistent infection, but fell to normal if appropriate therapy was instituted. This result indicated that the neutrophils of the majority of patients with minor buras during acute infection were in an activated state both metabolically and functionally.The occurrence of sepsis was associated with a marked lowering of PMN-CL and OI values, but no difference was noted before and after the development of sepsis. The incidence of sepsis was 85.7% when PMN-CL was lower than 2 cpm × 103. PMN-CL was lower when the sepsis was due toPseudomonas aeruginosathan withStaphylococcus(1.45 ± 0.23 vs. 3.08 ± 0.54 cpm × 103,p< 0.01).A close correlation was also found between PMN-CL and OI (r= 0.68) as well as PMN-CL and the levels of serum transferrin (r= 0.64;p< 0.01).It is tentatively concluded from this study that PMN-CL may provide a rapid, sensitive, noninvasive, and objective method for assessment of both aspects of the humoral-phagocyte immunity. Its measurement would be useful to alert physicians to an impending sepsis and prompt a thorough search for its source and early administration of appropriate treatment.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

From August 1980 through May 1984, 102 adult pedestrian patients with 130 tibial fractures were admitted to the Shock Trauma Center of the Maryland Institute for Emergency Medical Services Systems. We reviewed their records for admission status, procedures performed, and results: 32 patients who died, underwent primary amputation, or were lost to followup were excluded, leaving 70 patients with 86 tibial fractures as the base study group. We grouped the data by year of admission and analyzed it in terms of the effects of changes in the treatment protocol on results, specifically the time to union. For the first year, the existing treatment protocol included: antibiotics, debridement and irrigation with a bulb syringe, stabilization according to wound size and surgeon preference, split-thickness skin graft, and bone grafting in response to delayed or nonunion. The average time to union for Grade III fractures was 58.39 weeks; average time overall was 53.95 weeks. In the fourth year, the altered treatment protocol included: antibiotics, debridement and jet lavage, scheduled rebridement, external fixation for open fractures, judicious use of open reduction/internal fixation for closed fractures, early free flap soft-tissue coverage, and early bone grafting by history and fracture pattern. The average time to union for Grade III fractures was 37.65 weeks; average time overall was 34.46 weeks. From the first to the fourth year, time to union for Grade III fractures decreased by 64.5% and time to union overall decreased by 63.9%. We feel the decrease is a direct result of early bone grafting, the fixator construct used, and judicious use of open reduction/internal fixation.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Advances in prehospital care and the development of regionalized trauma centers have reduced the mortality from major trauma. However, patients who have sustained severe brain injuries (Glasgow Coma Score ≤ 8) treated in such a setting still have a substantial mortality. In order to determine if mortality is a function of severe brain injury, 545 trauma patients with and without severe brain injury were prospectively studied. All patients were similarly treated by one medical center from the actual site of injury until discharge from the hospital. There were 104 patients who had sustained major blunt trauma with severe brain injury and 441 patients who had sustained major blunt trauma without severe brain injury. The mortality of the former group was 30.8%, whereas that of the latter group was 0.9% (p< 0.0001).

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We treated 60 patients with blunt liver injury over 14 years. According to Makiya's scale of severity, 22 of these lesions (37%) were of Type I, 23 (38%) of Type II, and 15 (25%) of Type III. The overall mortality rate was 23% (14 patients). Changes in hepatic function were studied in these patients. Transaminase levels showed abnormal elevations immediately after the injury but rapidly decreased to normal levels within about 40 days in both the patients who survived the injury and those who died. The alkaline phosphatase activity showed moderate gradual elevations with time, exceeding 20 K.A. units 10 days after the injury in those who died. The total bilirubin level increased to only about 4 mg/dl in those who survived but exceeded 8 mg/dl 10 days after the injury in about 80% of those who died. The total cholesterol level decreased below 100 mg/dl in those who died. In chloric cobalt reaction, the R-value shifted to the left in those who survived but to the right in those who died. Total plasma protein, which decreased to about 6.0 gm/dl immediately after the injury, gradually recovered in those who survived but further declined in those who died. Percentage of gamma-globulin increased but remained below 20% in those who survived but exceeded 20% within 10 days of injury in many of those who died. Hepatic functions 5 years after the injury were generally within the normal range.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

In a porcine model of severe septic acute respiratory failure produced by continuous infusion of livePseudomonas aeruginosa, the role of the complement system was studied by pretreating animals with cobra venom factor (CVF) to deplete C3. Three groups of spontaneously breathing animals were monitored with Swan-Ganz and arterial thermodilution catheters. Group I was pretreated with 80 U/kg of CVF iv 16–18 hours before testing. Group II receivedPs. aeruginosaiv (2 × 108/20 kg/minute). Group III was pretreated with CVF and later given the Pseudomonas infusion. The CH50as a measure of complement activity was less than 7% of normal level in Groups I and III. No changes in respiratory variables occurred in Group I. In Group II, the mean pulmonary artery pressure doubled, intrapulmonary shunt fraction (Qs/Qt) increased, PaO2decreased, and extravascular lung water doubled in 4 hours. In Group III, the pulmonary hypertension, hypoxemia, increase in Qs/Qt, and increase in EVLW were all significantly less than in Group II. Neutropenia occurred with the Pseudomonas infusion in Groups II and III.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Fifty-five patients requiring oral surgery and orthopaedic care were studied prospectively and compared to a control group. Six patients received no antibiotics and one developed an orthopaedic operative site infection due to a mouth organism. Seventeen patients had concurrent surgery and perioperative antibiotic usage and no infections occurred. Twenty-six patients required multiple operations and courses of antibiotic treatment and five developed infections.Enterobacterinfections were common and emerge because they are resistant to first-generation cephalosporins. Treatment by a perioperative first-generation cephalospor in is recommended, followed by throat cultures and treatment by antibiotics specific for cultured organisms for patients requiring subsequent operations.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Anemia is one of a large number of systemic changes occurring in severely burned patients and has a multifactorial etiology including hemorrhage, hemolysis, and depression of the rate of erythropoiesis. In previous studies, it was found that serum of burned humans and animals contained a substance(s) capable of interfering with red cell colony formation in vitro. Here are reported studies done in an attempt to characterize further the inhibitory activity. The molecular weight was more than 50,000 daltons by ultrafiltration. By gel filtration an inhibitory region was identified with an approximate molecular weight range of 140–290,000. Treatment of sera with proteolytic enzymes resulted in loss of activity suggesting that the inhibitory substance(s) was a protein. Ion exchange chromatography indicated that the inhibitor was an acidic protein. It is suggested that this material participates in the pathophysiology of the anemia of thermal injury by depressing red cell production.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A procedure for the surgical correction of depressed tracheostomy scars and tracheocutaneous fistulae is described which involves reapproximation of the strap muscles and the selective application of a subcutaneous Z-plasty. The results are predictable, satisfactory, and the procedure is quite simply accomplished. Utilization of the Z-plasty improves contour in patients with atrophic tissue and assists the distribution of tension forces in subcutaneous and muscular layers.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Peripheral blood from asplenic trauma patients (ASP) was analyzed for immunoglobulin concentrations, complement levels, T- and B-lymphocyte populations, and mitogen response of T cells, and compared to a similar analysis performed on the blood of normal controls (C). The interval from splenectomy to testing averaged 1,471 ± 193 days (mean ± SEM) in the ASP. Total lymphocyte count averaged 2,941 ± 234 in the ASP with a T-cell count of 2,030 ± 182 and a B cell count of 351 ± 58. The average control lymphocyte count of 1,769 ± 147 was significantly less than ASP (p< 0.001) as were the T-cell count of 1,328 ± 107 (p< 0.005) and the B-cell count of 124 ± 18 (p< 0.001). Responses to PHA were diminished in ASP lymphocytes by 38% at 3 days (p< 0.01) and by 49% at 5 days (p< 0.001) when compared to C. Levels of IgM were significantly decreased (p= 0.05) in ASP. Levels of C3, C4, and C5 were similar in ASP and C. These data demonstrate persistent abnormalities in immune function in adult ASP without underlying lymphoreticular disorders and suggest a possible explanation for the increased septic risk in this patient group.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID