摘要:

Intracranial pressure was increased in cats by infusing ‘mock’ CSF intracranially, thus decreasing cerebral perfusion and oxygenation. The cats then randomly received either 50% 02or 50% 02—5% CO2by inhalation. As monitored by in vivo near-infrared spectroscopy (NIR), no improvement was noted after 50% O2whereas 50% O2-5% C02resulted in increased perfusion, an oxidation of cytochrome a,a3, an increase in oxyhemoglobin, and reduced quantities of de-oxyhemoglobin (p < 0.01) despite a further increase in intracranial pressure. The authors conclude that: a) NIK is a useful means of noninvasively and directly assessing brain metabolism and has advantages over simple ICP monitoring; and b) continued investigations of C02as a possible therapeutic modality after head injury appear warranted.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Injuries to the larynx and cervical trachea are uncommon, making the development of treatment protocols and subsequent data analysis in any one hospital difficult. This prompted a review of our experience with emphasis on variables related to long-term morbidity. The records of 20 patients with laryngotracheal injuries seen at the Montreal General Hospital from January 1974 to December 1984 were reviewed.The majority were young males (18 to 20 years old), and there was blunt trauma in 14 and penetrating trauma in six. The level of injury was laryngeal in 16 and tracheal in four.There were no airway-related deaths. One patient died with uncontrollable retroperitoneal hemorrhage before definitive repair of the tracheal transection. All but two of the remaining 19 patients had significant morbidity in the form of aphonia, dysphonia, or airway stenosis.The major factors contributing to the high morbidity were delay in diagnosis, anatomic level of injury, and associated multisystem trauma. A high index of suspicion, liberal use of fiberoptic bronchoscopy for diagnosis, and early airway control will lead to earlier diagnosis. Computerized tomography of the upper airway facilitates definitive surgical repair. Long-term followup is essential. Laryngeal trauma remains a major challenge.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Benefits of immediate postinjury nutritional support remain ill defined. Seventy-five consecutive patients undergoing emergent celiotomy with an abdominal trauma index (A.T.I.) > 15 were randomized prospectively to a control group (no supplemental nutrition during first 5 days) or enteral-fed group. The enteral patients had a needle catheter jejunostomy (N.C.J.) placed at laparotomy with the constant infusion of an elemental diet (Vivonex HN) begun at 18 hours and advanced to 3,000 ml/day (3,000 kcal, 20 gm N2) within 72 hours. Control and enteral-fed groups were comparable with respect to demographic features, trauma mechanism, shock, colon injury, splenectomy, A.T.I., and initial nutritional assessment.Twenty (63%) of the enteral patients were maintained on the elemental diet > 5 days; four (12%) needed total parenteral nutrition (T.P.N.). Nine (29%) of the control patients required T.P.N. Nitrogen balance was markedly improved (p < 0.001) in the enteral-fed group. Although visceral protein markers and overall complication rate were not significantly different, septic morbidity was greater (p < 0.025) in the control group (abdominal infection in seven and pneumonia in two) compared to the enteral-fed patients (abdominal abscess in three). Analysis of patients with A.T.I. 15—40 disclosed sepsis in seven (26%) of the control versus one (4%) of the enteral-fed group (p < 0.01).Our clinical experience demonstrates the feasibility of immediate postoperative enteral feeding via N.C.J. after major abdominal trauma, and suggests this early nutrition reduces septic complications in critically injured patients.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Although enteral nutrition is considered more 'physiologic' than parenteral nutrition, there is greater published experience with parenteral nutrition in trauma patients. To compare the efficacy of these two techniques, we prospectively randomized multiple trauma patients during their admission laparotomy to receive either central venous parenteral nutritional (TPN: n=23) or enteral nutrition by jejunostomy (Jej: n=23). Nutritional support began on the first postoperative day; the study period continued a maximum of 14 days.There were no significant differences between the two groups in age, sex, injury severity, estimated caloric needs (3,322 TPN; 3,114 Jej), hours to achieve full prescription (77 PTN; 79 Jej), or the number of days on nutritional support (22 TPN; 25 Jej). Average daily caloric intakes, nitrogen balance results, and complication rates were also comparable.These results suggest that early postoperative jejunostomy feeding is a safe and efficacious choice for multiple trauma patients undergoing laparotomy.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Previous investigations have demonstrated reduction of postischemic organ injury with improved flow rates following administration of superoxide dismutase (SOD) and catalase (CAT) just before reperfusion. Presumably these oxygen-free radical scavengers provide protection against oxygen-free radicals produced during reoxygenation, but the site of action remains unclear. The present study was designed to determine the effect of SOD/CAT on hepatic function following global ischemia independent of flow. Livers obtained from Sprague-Dawley rats fasted 24 hours were perfused with Krebs-Henseleit buffer containing 5 mM lactate for 130 minutes. Following a 30-minute control period, livers were subjected to 55 minutes of warm, global ischemia. The control group (N =12) was reperfused under oxygenated conditions for an additional 45 minutes. Two other groups (TV=9; N=4) were reperfused under identical conditions with administration of 150,000 U/L or 450,000 U/L of SOD/CAT 3 minutes before reperfusion. Hepatic flow returned to normal levels following ischemia, but gluconeogenic activity and bile production remained significantly depressed. No significant recovery of gluconeogenic activity or bile production was noted when SOD/CAT was administered before reperfusion. These results demonstrate that in the absence of flow augmentation SOD/CAT do not provide protection from oxygen-free radicals following global ischemia in the isolated rat liver. This implies that previously reported reductions of postischemic reperfusion injury, where blood flow improved as well, may be due to oxygen-free radical scavenging within the vascular network resulting in enhanced organ perfusion and, therefore, improved organ function.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

From January 1982 through December 1983, 83 severely injured and hypovolemic patients were immediately resuscitated with uncrossmatched packed red cells. Seventy-four patients received 250 units (3.3 units/pt) of Group O red blood cells (TOB), and nine patients received 27 units of typespecific blood (TSB) (3.0 units/pt). Additionally, 53 units of TSB were transfused to the TOB group in the interval between TOB immediate transfusion and the availability of fully crossmatched blood. A total of 880 units (10.6 units/pt) were transfused without instance of transfusion reaction or subsequent crossmatching difficulty. The protocol called for two units of TOB (Rh positive for males, Rh negative for females) to be delivered to the resuscitation area before patient arrival. The decision to transfuse TOB was left to the surgeon in charge and was based on the clinical impression of severe shock. Thirty-eight per cent (31 patients) met the criteria of requiring a 'massive transfusion' (> 10 units within 24 hours). Overall, 28 patients (31%) died, 22 within hours of arrival. No death was attributable to transfusion reaction or blood incompatibility. Complications included one dysrhythmia, six patients developed ARDS (7.2%), and ten patients (12%) had 'DIC' Two patients developed positive hepatitis screens, and there was one clinical case of hepatitis observed. None of the 'DIC' cases were related to incompatible blood transfusion. We conclude that for immediate trauma resuscitation, TOB is safe and TOB has additional advantages over TSB or Type O whole blood transfusion.These include immediate availability, universal application for all recipients, and no risk of transfusing 'high titer' plasma. In addition, TOB use avoids the administrative, clerical, and technical errors possible when TSB is used in these urgent situations, especially those involving multiple patients.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We have prepared a polymerized pyridoxylated hemoglobin solution (Poly SFH-P) with a normal [Hb] of 14 gm/dl and a normal COP of 20 torr. Although this normal [Hb] is a significant improvement over prior products, the Pno of 16-20 torr raises a concern about the ability of Poly SFH-P to effectively transport O2in the presence of red cells with their normal Pr,o of 26 torr. This study quantitatively assessed the contribution of Poly SFH-P to total O2delivery and consumption in the clinically relevant range of hematocrits. The results document that Poly SFH-P supports life at zero hematocrit, and makes significant contributions to total O2delivery and consumption in the presence of red cells. Poly SFH-P permits a higher plasma [Hb], and has a longer intravascular persistence than any unpolymerized hemoglobin solution. Poly SFH-P is thus an effective O2carrier, and offers greater potential than prior products as a clinically useful red cell substitute

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Ex vivo hypothermic perfusion has been shown to enhance short-term survival of organs before transplantation. The effects of perfusion, control of media pH, and systemic drug treatment were studied utilizing superficial epigastric free flaps in Sprague-Dawley rats. Viability of the flaps could be reliably maintained (9/10, 90%) for 72 hours using simple storage in phosphate-buffered Ringer's (pH 7.8) at 4°C. Pretreatment with prostaglandin El was of slight benefit. Flap perfusion with or without pharmacologic agents was not beneficial.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We have quantitatively examined the effect of rapid sequential skin expansion on capillary blood flow in the porcine random flap model in order to determine the relation between the increased survivability of expanded random flaps and capillary blood flow. Three 6 x 20 cm random flaps were tattooed on the backs of six small (20-kg) pigs. One flap was not manipulated (control). A 450-ml expander was inserted at the base of the second flap and left in place (sham). At the base of the third flap a 450-ml expander was inserted and each day for 5 days sequentially filled to the limits of skin viability as determined by vital dye staining (expanded). Capillary blood flow was measured on day 8 by measurement of radioactivity after injection of 15- micron radiolabeled microspheres. Samples were taken at 4-cm intervals from the base of each flap. Rapid expansion led to significant increases in capillary blood flow in expanded skin and to enhanced preservation of capillary flow after elevation of random pattern flaps based on expanded skin compared to sham and to control tissues. This correlates with and explains at least in part our previous observation of improved length of survival of flaps raised on expanded skin.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Four fractures of the femur (three distal femoral and one intertrochanteric) were treated by sliding screw-plate procedures. Complications in all cases were caused by malassembly of the components. A lag screw of adequate length, proper parallel position of the components, confidence that the components are completely engaged, and, where appropriate, preliminary assembly with free, smaller lag screws, are recommended.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID