摘要:

This study was designed to document the early responses of the baboon to LD100E. coliinfusion with an emphasis on cardiovascular, respiratory, and metabolic alterations. Adult baboons were anesthetized, catheterized aseptically to monitor cardiopulmonary and systemic parameters, and infused with LD100E. coliintravenously for 2 hours. Cardiac output was determined with an Edwards Laboratory Thermodilution Cardiac Output Computer. Oxygen contents of systemic and pulmonary artery blood were determined with a Van Slyke Manometric Apparatus. Results demonstrate early significant increases in cardiac output, oxygen uptake, heart rate, rectal temperature, respiratory rate and minute volume, and decreases in mean systemic arterial pressure and total peripheral resistance. Pulmonary vascular resistance remained relatively constant. In conclusion, an early ‘hyperdynamic state’ has been detected in the baboon during lethalE. coliinfusion (similar to that documented in humans with sepsis) characterized by compensatory alterations in cardiovascular hemodynamics, respiration, and metabolism.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The effects of oleic acid (oleate) were examined using two in vitro model systems. In a concentration-dependent fashion oleate activated or inhibited the (Ca2++ Mg2+)-ATPase, or Ca2+pump ATPase, of membranes isolated from human red blood cells (RBC's). Concentrations of oleate which inhibited the Ca2+pump ATPase also inhibited the Na+-K+pump ATPase. Likewise, in a concentration-dependent fashion oleate increased or abolished ATP dependent45Ca2+transport into inside-out vesicles (IOV's) prepared from human RBC's. Addition of 500 μM oleate to IOV's which had already accumulated45Ca2+resulted in rapid loss of the ion. The effect was shown to be due to membrane disruption; a conclusion based on oleate-induced unmasking of latent acetylcholinesterase activity in IOV preparations. The results are compatible with, but do not prove, that membrane disruption caused by circulating free fatty acids and similar membrane active agents might play a role in the cellular injury associated with certain pathophysiologic states.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

During the 10-year period ending June 1982, 219 patients were treated for 269 injuries to the major vessels of the abdominal and thoracic cavities, with 28% morbidity and 32% mortality. One hundred eighty patients (82%) had 377 associated injuries consisting primarily of damage to the small intestine (79), liver (45), and large intestine (34). Factors associated with an increased mortality included: more than three associated injuries; two or more nonvascular complications; more than two vessels injured; admission to ER in shock; injury to abdominal aorta or inferior vena cava; and injury to the porta hepatis. The majority of deaths (73%) were due to acute blood loss and irreversible shock. Factors unrelated to acute blood loss and shock had minimal effects on survival.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The extent of osseous pelvic injury in patients suffering multiple organ trauma is difficult to assess. However, accurate information is essential in order to determine an acceptable treatment regimen, either operative (external or internal fixation), or nonoperative (bed rest and early ambulation). Twenty consecutive patients were treated for pelvic fractures from January 1981 through February 1982. All patients had multiple organ injuries, (average = 3.5 organ systems per patient). Each patient had an A-P X-ray projection of the pelvis in the emergency department (E.D.) as a part of the initial evaluation. Three patients (15%) required immediate laparotomy for associated abdominal injuries. Six patients (30%) required prolonged ventilatory support for pulmonary injuries. Computed tomography (CT) of the pelvis was performed on all patients within 4 days of admission.In seven patients, CT examination confirmed the findings of the routine X-rays obtained in the E.D. In 13 patients the CT examination demonstrated significant additional fractures of the pelvis which were not initially demonstrated in the E.D. A consistent pattern of either sacral fracture or injury to the sacroilic joint which was not appreciated on the initial E.D. X-rays was demonstrated in these 13 patients. Six patients underwent operative intervention, four with Hoffmann frames (external fixation), and two with reduction and internal fixation. CT examination of the pelvis provides a rapid and thorough evaluation which is extremely useful in demonstrating all the fractures of the pelvis on the single examination, thereby allowing the early determination of the best treatment plan for patients with such major injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

One hundred nine patients suffering blunt injury to the colon or rectum were treated between 1 January 1970 and 31 December 1980. Vehicular accidents accounted for 90% of the injuries and 91% of the fatalities. Multiple system injury predominated, with survivors averaging 1.9 and nonsurvivors 3.8 injuries/patient. Six cases were complicated by abdominal sepsis directly related to their colon injury. There were no deaths and no episodes of colonrelated abdominal sepsis among patients with isolated colon trauma. Of the 32 patients not surviving, four (3.7%), died as a direct result of their colon injury. Three of the four deaths appear to have been preventable.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Blood samples were obtained from 237 consecutive injured patients before any resuscitation. Microaggregate (MA) formation was measured by the screen filtration pressure (SFP) technique. Arterial blood gases were analyzed concomitantly and the respiratory index (RI) calculated. An Injury Severity Score (ISS) was calculated for each patient. The results show a significantly larger amount of trauma in the patients with the higher SFP results (p< 0.001). Associated with the increase in the amount of MA formation was a significant decrease in arterial pO2(p< 0.05) and a significant rise in the RI (p< 0.005), suggesting a correlation between MA formation and pulmonary impairment. Attempts to prevent or resolve MA formation may result in a decrease in the incidence or severity of post-traumatic pulmonary insufficiency.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The purpose of this study was to explore the possibility that nonpenetrating cardiac impact can directly result in hepatic and splenic injury through hemodynamic effects. Impact upon the anterior surface of the heart was produced in 34 open-chest anesthetized dogs. In 15 dogs the velocity of impact was 12 m/sec and in 19 dogs it was 18 m/sec. Pressure in the inferior vena cava transiently reached 194 ± 25 mm Hg in the dogs impacted at 12 m/sec and 377 ± 44 mm Hg in dogs impacted in 18 m/sec. Aortic pressure transiently reached 449 ± 32 mm Hg in dogs impacted at 12 m/sec and 682 ± 33 mm Hg in dogs impacted at 18 m/sec. Gross capsular lacerations of the liver occurred in six dogs (18%) following cardiac impact. All dogs showed hepatic congestion and most showed microscopic injury of liver cords, central veins, and portal tracts. Dogs that survived cardiac impact for the duration of observation (90 minutes) showed focal acute inflammation of liver triads and hepatic sinusoids, indicating a more subtle degree of injury. The spleens of eight dogs showed areas of grossly visible subcapsular hemorrhage. Subcapsular congestion of the spleen occurred in almost all dogs. This study shows therefore that nonpenetrating cardiac impact may result in hepatic and splenic injury. A likely mechanism may be the extraordinarily high venous pressure that develops at the instant of impact, although transient striking elevations of arterial pressure may also contribute.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Adult respiratory distress syndrome (ARDS) is a serjous complication of trauma and sepsis. We have earlier shown naloxone, an opiate antagonist, and eyproheptadine, an antiserotonin drug, to be effective in reducing pulmonary platelet trapping (PPT), which is thought to play an important role in the evolution of ARDS in endotoxin-shocked dogs. Endorphins are implicated as pathophysiologic factors in shock, and serotonin is a possible mediator of their action. The present study shows naloxone and cyproheptadine to be equally effective in protecting against PPT in dogs subjected to trauma, and when naloxone is given before the trauma it also obviates the hypotension associated with trauma. In addition, the naloxone- and cyproheptadine-treated animals did not show the increased platelet aggregability usually seen in traumatized dogs.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Surgeons are frequently called upon to place central venous catheters for various purposes. With the increasing used of central vein hyperalimentation, these catheters have become quite widely used. Often, critically ill patients require simultaneous infusions of vasopressors, fluids, blood and/or blood products, and hyperalimentation. In patients who have had peripheral intravenous catheters indwelling for king periods, often no peripheral access routes are available. Central venipuncture carries a definite risk of pneumothorax, hemothorax, and arterial puncture. The technique presented here allows the placement of multiple centra1venous catheters via a single venipuncture. Each catheter is a completely separate venous conduit and may be used to infuse any number of substances alone or concurrently with others.Materials needed for this technique are:One 18-gauge Thinwall needleTwo 20-cc Luer tip syringesTwo 16-gauge 8″ or 12″ intravenous cathetersTwo separate bags of infusion fluids and tubingsOne bottle 1% xylocaineTwo .035″ floppy end spring guidewires, 40 cm longOne 8 French percutaneous dilator-introducer kitOne 11 knife bladeOne mosquito curved hemostatSterile towels, gauze sponges, sutures of choice, antiseptic

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A retrospective review was carried out of 17 muscle and musculocutaneous flaps in the leg performed for traumatic and osteomyelitic defects in two groups of patients. One group of ten patients with soft-tissue defects resulting from trauma underwent muscle flap coverage in nine and musculocutaneous flap cover in one. Nine of the ten healed uneventfully. The second group of seven patients with defects resulting from chronic osteomyelitis underwent muscle flap cover in two, musculocutaneous flap cover in three, and combined muscle and musculocutaneous flap cover in two. All seven of the flaps transposed healed well without recurrence of infection. This series illustrates that the technique of muscle and musculocutaneous flap transposition can provide a safe, relatively straightforward method of cover for defects of the leg from trauma and chronic osteomyelitis with predictable results.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID