ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Ten cases of penetrating injuries to the duodenum are presented. Six injuries were treated with primary repair, retrograde decompressing jejunostomy, and feeding jejunostomy. There was no postoperative duodenal leak in any patient treated with primary repair and retrograde decompressing jejunostomy.In a review of 563 cases of penetrating duodenal trauma, the superiority of primary repair of duodenal injuries with decompression of the suture line by a tube inserted in a remote site of the bowel (stomach or jejunum) was demonstrated. This technique afforded the lowest mortality and incidence of postoperative duodenal fistulae.When applicable, primary repair with retrograde decompressing jejunostomy and feeding jejunostomy is a rapid, simple, and safe method for the treatment of penetrating duodenal injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

In the past decade 93 patients with deodenal injury were treated at a trauma center. By chart review, the age, sex, mechanism of injury, time to initial exploration (and the reason for delay), laboratory results, associated injury, extent of deodenal injury, operative repair, use of drains and tube decompression, morbidity, and cause of death were tabulated in order to improve management of these injuries.Of 87 patients surviving until the time of operative repair 73% required no repair (four) or primary closure (59). The remainder had either resection with primary anastomosis (ten), diverticulization (12), or pancreaticoduodenectomy (two).All patients with penetrating trauma were immediately explored. Patients with blunt trauma were explored on the basis of the judgment of house staff and faculty. Overall mortality was 18%. Significant morbidity occurred in 49% of survivors.This urban experience was heavily weighted towardpenetratinginjury. In this group early death usually resulted from associated vascular injuries.Bluntduodenal injury was less frequently associated with immediate exsanguination. Mortality associated with blunt duodenal injury was usually the result of delayed diagnosis. In blunt duodenal trauma peritoneal lavage is not diagnostic and may often be misleading; in this series 50% of lavages were false negatives. Blunt duodenal trauma, particularly when combined with pancreatic injury or delayed repair, was a lethal combination. A high index of suspicion and aggressive diagnostic evaluation (CT contrast study/amylase) in the emergency department is required in equivocal cases to avoid morbidity and mortality.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A mileage population death index (MPDI) was devised to compare the death rate from motor vehicle trauma in Florida counties. The MPDI was defined as the average death rate per one hundred million miles driven divided by the population of the particular county × 105. The resultant MPDI was correlated with the presence in a county of basic life support only and advanced life support. In addition, counties with large metropolitan hospitals which might possibly classify as Level I institutions were compared with other counties. A low MPDI was found to be highly correlated with the presence of an ALS system (p= 0.001). Counties with hospitals which might qualify as Level I also had a significantly lower MPDI (p= 0.04). We conclude that the presence of advanced life support and a sophisticated hospital is correlated with a significantly lower motor vehicle mortality.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Of 56 patients with penetrating colon injuries over 6 years, 15% underwent exteriorized repair, 21% received a colostomy, and 64% were treated with primary repair. Of the eight exteriorized repairs, four required conversion to colostomies. In the entire group of 12 colostomies, there were two deaths, four abscesses, and one empyema.Thirty-six patients (64%) underwent primary repair. In this group there was one superficial wound infection, one empyema, but no intra-abdominal abscesses. Eighty per cent had associated injuries. All laparotomy incisions in the primary repair group except two were closed primarily. Large amounts of saline irrigant were used in all cases. All patients received broad spectrum antibiotics pre- and postoperatively.Primary repair of colon injuries can be done safely in many cases. Proper attention must be given to the associated injuries, the patient's general condition, and the time interval between injury and repair. We now find few indications for exteriorization of injured colons. Colostomies are done if our criteria for safe primary repair are not fulfilled.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

One hundred thirty six patients with penetrating colon injuries (gunshot wounds, 95; stab wounds, 41) were retrospectively analyzed. A scoring system, the Penetrating Abdominal Trauma Index (P.A.T.I.), was employed to quantitatively assess the severity of injuries in each patient. Of 67 patients with right colon injuries, 48 (72%) were treated definitively by primary repair (32) and by resection and ileocolic anastomosis (16), with minimal morbidity. In 69 patients with left colon injuries, 47 (68%) were treated by colostomy (28) and by exteriorized repair (19). Overall, exteriorized repair was successful in 74% of patients. All five mortalities (3.7%) were related to associated injuries. It is concluded that the majority of the right colon injuries can be treated definitively. Exteriorized repair should be the preferred method whenever colostomy is considered, except in severe left colon injuries requiring resection.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

CT scans of 73 patients with acute thoracic/lumbar spine injuries from T3 to L5 were reviewed. Injuries were classified as burst fractures (48), fracture-dislocations (ten), wedge compression fractures (11), and seatbelt-type injuries (four). Thirty-one (42%) had motor deficits due to spinal cord or nerve root damage. Such neurologic deficits were present in all patients with fracture-dislocations, and 60% of those with burst fractures. Seven patients, four initially normal, developed progressive neurologic impairment early after injury. Burst fractures, one with dislocation, were the spinal injury associated with each progressive deficit. Burst fractures at T12 or LI with 50% or more decrease of the mid-sagittal neural canal diameter had a significant risk of neurologic involvement, and of progressive deficit. CT scans demonstrate vertebral column damage well, and help identify those patients at risk of acute neurologic compromise.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The creatinuria after musculoskeletal injuries was studied in 31 patients. In addition to creatine the urinary outputs of creatinine, total nitrogen, and 3-methylhistidine were studied. Plasma creatine, creatinine, and guanidinoacetate concentrations were measured in some patients. In rats the effect of bilateral hind-limb ischemia was observed on the urine outputs of creatine and creatinine, and on the creatine, protein, and DNA contents of the hind limbs and carcass.In man the creatinuria was positively related to the severity of the injury and this relationship was stronger than with the urinary output of either creatinine or total nitrogen. In the rat creatinuria was related to the duration of the limb ischemia. The mechanism of the creatinuria is not known but the experiments on rats showed part of the excess creatine to be derived from the damaged muscle and excreted shortly after the injury, and part from the undamaged muscle of the carcass which provided the delayed excretion. It is suggested that creatinuria could be used as an indicator of the post-traumatic 'flow' phase.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Nine patients with invasiveEnterobacter cloacaeburn wound sepsis were identified in a series of 400 admissions to our Burn Center. In vitro antibacterial testing of topical agents revealed sensitivity to nitrofurazone cream. Treatment of this series of patients with nitrofurazone resulted in an overall 66% survival compared with an 86% mortality reported in the literature. We recommend that topical antibacterial sensitivity testing be routinely performed in the microbiology laboratory for isolates from burn patients, and that nitrofurazone cream be included among the agents tested for effectiveness.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID