ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The question addressed in this study was whether exogenous insulin can enhance the rate of assimilation of blood glucose after prolonged hypovolemia when homeostasis is waning. Twenty-three well-fed mongrel dogs were maintained at a mean arterial blood pressure of 50 mm Hg by bleeding. Periodic analyses were made of arterial and venous plasma concentration of glucose, femoral blood flow, arterial plasma concentration of insulin, and hematocrit. At the onset of physiologic deterioration signaled by the need to reinfuse 50 ml of shed blood to maintain 50 mm Hg blood pressure, dogs received either 10 ml saline (control;n= 15) or 10 ml saline containing 2 units insulin (treated;n= 8). Administration of 2 units of insulin to eight of the dogs caused a significantly faster decline of blood glucose than that observed in saline-treated animals. Despite the more rapid decline in plasma concentration of glucose in animals that received insulin, there was no significant difference in glucose uptake between the two groups of animals. The hemoconcentration reflected by a rising hematocrit that develops when hypovolemia persists was accentuated by the administration of insulin without supplementary fluids. The absence of any effect of insulin on glucose uptake in the hindlimb in the late phase of hypovolemic shock suggests that the accelerated decline in arterial glucose levels may be due to inhibitory effects of insulin on hepatic glucose release. These results are not consistent with the resistance of plasma glucose to insulin in the late phases of hypovolemic shock.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The effect of impact velocity and displacement on pulmonary injury in rabbits was investigated by producing a series of nonpenetrating anteroposterior sternal impacts involving velocities of 5 to 18 m/s and displacements of 2 to 45 mm. Contusion of the bronchial region was dominant at impact velocities below 6 m/s and displacements above 20 mm; contusion of the alveolar region was dominant at impact velocities above 15 m/s and displacements above 2 mm. When impact velocity and displacement were high, both bronchial and alveolar regions were injured. Pulmonary injury severity, expressed as a severity index adopted from the Abbreviated Injury Scale 1976 (AIS), correlated well with impact displacement at a given velocity but poorly with the peak reactive force, impulse transfer, peak esophageal pressure, or the amount of available energy.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Pulmonary artery pressure is frequently elevated in patients with post-traumatic pulmonary dysfunction. To ascertain whether or not this increase is reversible and what effects such reversal would have on gas exchange, the vasodilators nitroprusside and nitroglycerine were administered to 11 such patients. Pulmonary hemodynamics and gas exchange were observed. Mean pulmonary artery pressure and pulmonary vascular resistance decreased and pulmonary shunt increased. Cardiac output did not change. These results imply that much of the increase in pulmonary artery pressure is due to a reversible restriction of blood flow past unventilated alveoli. Hypoxic vasoconstriction is postulated to be a major cause of the increase in pulmonary artery pressure.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Reduction of distal radius fractures is often difficult to maintain with plaster casting alone. Achieving this goal with an easily executed technique which carries a low morbidity is desirable, especially in multiply injured patients. Between July 1977 and September 1980, 24 high-energy fractures of the distal radius in 22 patients were treated by percutaneous pinning of the radial styloid fragment to the opposite radial cortex. Roentgenograms at the time of pinning and 8 weeks or more in followup demonstrating healing were available in 20 patients (22 fractures). Using a previously described method of roentgenographic grading, these cases were evaluated. At followup five fractures were felt to be anatomically excellent, 16 good, and one poor. Five fractures in review were felt to be not ideally pinned and these represented three of the five fractures that lost a grade of evaluation rating during healing. One superficial pin tract infection developed and two patients complained of local pin discomfort. These complications resolved with pin removal. If guidelines for pinning are followed properly, percutaneous pinning provides a simple and useful method for maintaining reduction in unstable distal radius fractures in multiply injured patients.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

This experimental study demonstrates the rigidity and durability of Knowles pin fixation of femoral neck fractures. Embalmed proximal femora were utilized. A 'fracture' was created by osteotomy, then reduced and fixed with Knowles pins. Four groups of reduction and pin configurations were created ('optimal reduction and pinning,' 'poor reduction,' 'inadequate pinning,' and 'comminution') to simulate the clinical situation. With the Materials Testing Systems (MTS) machine, 3 months of walking by a patient with a femoral neck fracture were simulated. Results suggest that Knowles pinning of a femoral neck fracture can provide adequate support for immediate full weight-bearing ambulation until fracture healing. Stability and durability of fixation are compromised by loss of cortical bone support by 'comminution,' short nonparallel pins not engaging the subchondral bone, and osteoporosis evidenced by a low Singh index.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Prompt operative intervention to obtain vascular control is the most important factor in the treatment of intra-abdominal vascular injuries. In 81 patients with major abdominal vascular injuries, bullet wounds were the cause of injury in 51, stab wounds in 12, blunt trauma in ten, shotgun in seven, and one was an iatrogenic injury from insertion of a dialysis catheter. Twenty-nine of 81 patients died (35.8%). Twenty patients (70%) died of massive blood loss at operation or in the early postoperative period. Hypovolemic shock was the predominant distinguishing feature in the mortality group. The mortality rate increased with the increasing number of associated nonvascular injuries, ranging from 20% in patients without associated injuries to 100% in patients with five or more associated injuries. The mortality rate was also increased with the number of vessels injured, ranging from 29% with one or two injured vessels to 100% with four or more. Late deaths occurred in nine patients and were most commonly related to the complications of hypovolemic shock. In hospital settings where patients can be resuscitated in the operating room, prolonged stay in the Emergency Department for diagnostic and laboratory evaluation only delays the operative vascular control of exsanguinating hemorrhage.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The use of the Hoffmann apparatus has been extended to include primary cross-leg myocutaneous flaps. Three patients are presented with severe soft-tissue loss to the lower extremities. The Hoffmann apparatus was used for stabilization and proved to be very beneficial for neurovascular monitoring, graft and wound care, and patient comfort.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Missile embolization to the pulmonary artery is rare. The diagnosis is suspected if a missile is seen on radiograph in a lung field without hemopneumothorax or pulmonary contusion. Treatment of the injury and embolic sites is indicated. We report a case of missile embolization to the lung associated with a carotid-jugular arteriovenous fistula.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Factor XI (PTA) deficiency, a coagulopathy, has been found to be relatively common in Ashkenazi Jews. Clinically it may manifest itself by varying forms of hemorrhage including postoperative bleeding. It is recommended that all Ashkenazi Jews have a partial thromboplastin time (PTT) coagulation test before surgery in order to rule out this coagulopathy, and if the PTT is abnormal a Factor XI assay should be done to confirm the diagnosis and ensure that proper therapy can be provided. A surgical case is presented with its ensuing complications resulting from lack of such information.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID