ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Recent enthusiasm for intraoperative autotransfusion has overshadowed critical assessment of its potential risks. In this study, adult mongrel dogs underwent controlled intraperitoneal hemorrhage of twice their estimated blood volume over a 4-hour period. The blood was replaced by an equal volume of banked blood (Group I,n= 5), or collected and reinfused via the Sorenson® System (Group II,n= 6), or the Haemonetics Cell Washing Device® (Group III,n= 6). Acid citrate dextrose was the local anticoagulant for Groups I and II, and heparin for Group III. Pulmonary capillary wedge pressure and cardiac output were maintained at baseline values with crystalloid infusion. Core temperature, pO2, and systemic pH remained normal throughput the 4 hours of evaluation.Red blood cell recovery was efficient in all animals, and the 2,3 DPG levels remained normal in the autotransfused dogs. Thrombocytopenia, however, developed uniformly and was more pronounced after autotransfusion. Platelet numbers decreased nearly 45% in the Sorenson as well as Haemonetics animals. Additionally, platelet dysfunction occurred after one blood volume exchange as evidenced by prolonged bleeding times and loss of the secondary wave on Sonoclot profiles. Coagulation studies revealed progressive consumptive coagulopathy and fibrinolysis in autotransfused dogs. The P.T., P.T.T., and T.T. lengthened, and levels of factors II, V, VIII, and fibrinogen fell.Autotransfusion clearly eliminates the infectious and incompatibility problems of banked homologous blood. Despite advances in technique, however, consumptive coagulopathy, fibrinolysis, and platelet dysfunction occur. The risk of these complications may outweigh the benefits of autotransfusion in the critically injured patient with multiple potential bleeding sites.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Over a 2-year period, 100 consecutive patients more than 70 years of age with multiple injuries were evaluated at a metropolitan trauma center for injury patterns and factors that affected survival. The analysis incorporated mechanism of injury, body region affected, Injury Severity Score, shock, change from level of prehospital function, and mortality. The mortality for the group was 15%. It was found that the Injury Severity Score was not predictive of survival in the elderly injured. However, central nervous system injury (p< 0.01) and hypovolemic shock (p< 0.001) were predictive of survival. While 85% of the injured patients survived, 88% of these did not return to their previous level of independence.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Previous reports on the use of the serum amylase level to assess pancreatic injury in patients with blunt abdominal trauma have been disappointing. The availability of methods to measure the serum isoamylases (P & NP) might be expected to improve the accuracy with which the serum amylase level is used.Sixty-one patients treated for a variety of blunt trauma injuries were studied. All categories of injury were included. Isoamylase levels were determined from admission sera and were compared to injuries found at laparotomy. Three patients had major pancreatic injury but only two of these patients showed a rise in the pancreatic isoamylase. Sixteen additional patients had a rise in the pancreatic isoamylase without evidence of pancreatic injury. Eight of these patients had no component of abdominal injury whatsoever. Two patients with isolated head injury had substantial elevations of pancreatic isoamylase.The regulation of serum amylase is multifactorial and variable. The measurement of serum isoamylase levels does not offer great improvement over the serum amylase in evaluating patients with blunt abdominal trauma.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Twenty-five inflatable and two semi-rigid rod type penile prostheses have been implanted in 27 patients with erectile failure following pelvic trauma. Reoperation was required in 13 patients in the inflatable prosthesis group but ultimate success and satisfaction were achieved in 92%. The etiology of erectile failure following various types of trauma is reviewed, as well as the approach to the evaluation of erectile failure in such a patient. Where etiology-specific corrective therapy is not possible, the penile prosthesis has proven to be an acceptable form of substitution therapy.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Recent studies suggest that the hyperglycemic response to hemorrhage and shock may play a role in promoting plasma refill via its hyperosmolar effect. This relationship was tested in a bilaterally adrenalectomized rat model. After a left carotid arterial cannulation, seven adrenalectomized rats and seven control rats with intact adrenal glands were bled periodically for periods of 15 min followed by 15 min of rest. The initial hemorrhage depleted 7.5% of the total blood volume (TBV) and subsequent hemorrhages 5% each. The study period extended up to 120 min to replicate a hemorrhage of 22.5% of TBV. Micromethod hematocrits (Hct) and blood sugar (BS) were monitored every 15 min and results were analyzed by use of a BMD-P statistical package on an AMDAHL 470 computer. A significant (p< 0.05) increase in BS during shock was seen in the control rats, while the adrenalectomized animals did not demonstrate a significant hyperglycemic response.There was no significant difference in the plasma refill observed between the two groups. At 60 min, the Hct fell 3.6 ± 1.7 and 4.6 ± 0.6 percentage points for control and adrenalectomized animals, respectively, while at 120 min, a respective Hct drop of 7.5 ± 1.6 and 5.4 ± 1.1 percentage points was noted. This study indicates that the absence of the hyperglycemic response in the adrenalectomized rats had no effect on plasma refill when compared to the response of control rats with intact adrenals.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Eight severely burned patients received 10 grams twice a day of enterally administered ornithine alpha-ketoglutarate. Variations in their plasma and urinary amino acid levels were compared with those from six severely burned control patients. The study covered the period from the fourth day to the twenty-eighth day after injury. Essential differences between the two groups were that plasma ornithine and proline increased until day 13 in the treated group, plasma phenylalanine levels were higher in the control group except on day 13, the peak, on the twenty-first day, in plasma concentrations of valine, leucine, isoleucine, tyrosine, lysine, proline, and ornithine, in the control group was not found in treated subjects, and urinary amino acids were lower on day 28 in the treated group. These results suggest that ornithine alpha-ketoglutarate administration lowered protein catabolism after injury, probably through a process mediated by increased secretion of insulin and human growth hormone.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The records of 92 patients who sustained fractures of the transverse processes of thoracic or lumbar vertebrae between 1976 and mid-1982 were reviewed. The majority were injured in motor vehicle accidents. Trauma to abdominal viscera occurred in 19 patients including hepatic injuries in six, splenic injuries in 12, and colonic injuries in five. Hematuria was present in 51 patients and five of 51 had urinary tract injury requiring operative treatment. None of 34 patients without hematuria incurred anatomic disruption of the urinary tract. Thirty-two patients suffered other associated injuries, including thoracic, orthopedic, maxillofacial, and cerebral trauma. Fifteen patients incurred other spinal injuries. The overall mortality was 11% (ten patients). The mean Injury Severity Score in the 92 patients was 13.9. The frequency of abdominal visceral trauma with this bony injury (19/92—21%) suggests great energy expenditure and should alert physicians to seek other severe injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Although shotgun and gunshot injuries are frequently grouped together, shotgun injuries are ballistically and clinically very different from gunshot wounds. Because of the differences between gunshot and shotgun injuries, the clinical records of 85 patients with 112 extremity shotgun wounds treated over a 6-year period were reviewed: 11% had Type I injuries; 30% and 59%, respectively, had Type II and Type III injuries. Overall, 59% had major soft-tissue injuries and 44% had bone or joint injuries, and nerve and vascular injuries were documented in 21% and 26%. The major cause of a prolonged hospital stay was the presence of a major soft-tissue injury, while the presence or absence of a neural injury was the most important determinate of whether the extremity would be functional. In contrast, neither skeletal nor vascular injuries resulted in long-term extremity disability. Thus, we recommend an aggressive operative approach towards early wound closure in these patients to decrease hospitalization time. Further, we believe that the operative determination of the presence or absence of anatomic damage of the nerves in patients with neural deficits is an important component in the long-term management of these patients.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A study was undertaken to clarify the usefulness of the Rush pin intramedullary semirigid nailing technique in the treatment of 88 antebrachium fractures in 48 consecutive adult patients during the years 1966 through 1977. Of the patients 45 were followed for an average of 7.6 years (range, 2–14 years). The clinical results (antebrachium and wrist movements) were good in 78% of the cases with few complications. Union was delayed in five cases. There were no cases of wound infection, nonunion, or bone atrophy. The method was suitable for almost all types of fracture, even in elderly patients. Severe comminuted fractures with a shortening tendency on the radius require a special technique to prevent ulnar variance. The low degree of operative trauma may contribute to the excellent results obtained with the Rush technique.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID