摘要:

Glucagon has been implicated in the hormonal-metabolic response to injury and in the restitution of blood volume. Evidence for this has been obtained largely from observations of peripheral glucagon concentrations. The secretory response to mild or moderate hemorrhage remains undefined. Experiments have been conducted in conscious dogs surgically prepared with indwelling catheters in the portal vein (PV), femoral artery (FA), and femoral vein (FV). In addition, electromagnetic flow probes were placed about the PV and the hepatic artery (HA). Animals were subsequently subjected to either a 10% (7.5 ml/kg), 20% (15 ml/kg), or 30% (22.5 ml/kg) 3-min hemorrhage. The portal venous delivery rate (PVDR) of immunoreactive plasma glucagon (IRG), portal venous IRG concentrtion (PVIRG), and peripheral arterial IRG (AIRG) demonstrated variable changes following hemorrhage. When hemorrhage resulted in marked deterioration in PVBF, then PVDR did not correlate with either changes in PVIRG or AIRG. These preliminary results suggest that inferences regarding changes in PVDR of IRG cannot reliably be based solely on changes in hormonal concentrations, especially when measured only in the periphery. Moreover, since marked increases in peripheral plasma glucose levels were observed at times when PVDR of IRG was severely depressed following 20% and 30% hemorrhage it is suggested that glucagon may not play the dominant role in the early hyperglycemic response to hemorrhage.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The indiscriminate application of thoracotomy in the resuscitation of trauma has recently been challenged. Since 1 May 1974 400 consecutive trauma patients have undergone resuscitative thoracotomy in our Emergency Departments (ED). The mechanism of injury was blunt in 195 (49%) patients, gunshot wound in 147 (37%), and stab wound in 58 (14%) Upon arrival in the ED, 352 (88%) patients had no obtainable blood pressure (BP), 334 (84%), fixed pupils, and 315 (79%) failed to exhibit agonal respirations or other waning signs of life.One hundred six (27%) patients reached the operating room and 28 (7%) survived to be admitted to the intensive care unit. Sixteen were eventually discharged from the hospital, but four of these survivors had sustained irreversible cerebral damage. Overall, 12 of 400 (3%) patients survived ED thoractomy with intact neurologic function.Four factors appeared predictive of poor prognosis. There were no survivors with intact neurologic function among: 150 patients sustainingblunt trauma and arriving in the ED without signs of life(BP, pupil reactivity, respiratory effort); or 87 patients withpenetrating torso injuries who had no signs of life at the scene.Following thoractomy, in the absence of cardiac tamponade, there were no intact survivors of 124 patientswithout cardiac activityor of 180 whosesystolic BP failed to rise above 70 mm Hg in response to thoracic aortic occlusion.We believe the above factors should militate against initiating resuscitative thoracotomy in the ED or in deciding to continue heroic measures following thoracotomy.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Cervical spine immobilization devices are widely used to stabilize the cervical spine and prevent neurologic deficits associated with unstable fractures. In order to quantitate their efficacy we measured controlled cervical spine motion in three axes, using six different immobilization methods in 25 volunteers instructed to actively move their necks as much as possible in the directions of flexion, extension, rotation, and lateral bending while lying supine. Control measurements were made with no device and measurements were repeated following immobilization with: soft collar (SC), hard collar (HC), extrication collar (EC), Philadelphia collar (PC), bilateral sandbags joined with 3-inch cloth tape across the forehead (ST), and the combination of sandbags, tape, and the Philadelphia collar (ST/PC). Neck movements were reported in degrees recorded on a hand-held goniometer. There were no significant differences between control and SC measurements except in rotary movement. PC was not significantly better than the other two types of hard collars, except in limiting extension. ST immobilization was significantly better than any of the other four methods used alone, for all four movements. The addition of PC to ST was significantly more effective in reducing extension only.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Defects of the heel represent a difficult reconstructive problem. Previously described methods have not always been ideal especially for the posterior heel. The weight-bearing functional requirements of the heel tissue over the calcaneus are a sensitive, well padded, durable cover. The technique of choice should provide local similar tissue plus involve a single reliable operative procedure.Skin grafts placed on the calcaneus or on a muscle transposition flap, such as the flexor digitorum brevis, abductor hallucis, or abductor digiti minimi muscle, provide a thin, insensitive, and dissimilar surface. The cross-foot, cross-leg, cross-thigh, and buttock flaps provide more bulk and thicker skin. These flaps involve a prolonged hospitalization, multiple procedures, increased morbidity, and insensitive tissue. The dorsal foot island flap and microvascular free flaps are a one-stage procedure with less morbidity. The donor tissue is still too dissimilar to provide the protection and durability to this area. Random plantar flaps have provided a functional replacement with similar tissue having adequate sensation. However, these random flaps are not always reliable, have limited motion, and are limited usually to small defects.Recently the myocutaneous flap has been proposed using the flexor digitorum brevis muscle. This neuro vascularized flap is larger and more reliable. Our dissection study of plantar tissue using microlatex injected feet has expanded the plantar flap for easier heel coverage and provided a predictable flap area. By mobilizing the pedicle proximally to the posterior tibial artery, the flap has an expanded coverage arc. Thus the heel is covered with a sensitive and durable tissue to allow weight bearing, frictional trauma, and ambulation.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Microvascular free flap transfer has added new dimensions in reconstructive surgery. The use of musculocutaneous units as free flap donors may have additional advantages over skin units. Microvascular free musculocutaneous flaps were utilized to cover avulsion wounds in the lower leg of six patients and satisfactory results were obtained. The latissimus dorsi musculocutaneous flap proved to be well suited for free transfer to the traumatized lower extremity, because of its long dominant vascular pedicle, its large size, and the minimal functional problems that result from its use.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Over a 5 1/2-year period 30 patients were found withEikenella corrodensinfections of the hand following closed first injury. Twenty-four had mixed infections; six grew pure cultures ofEikenella.Twenty-one of the 30 patients had positive cultures from an injured metacarpophalangeal joint. A delay in presentation or an inaccurate initial diagnosis appeared to be the most significant factors leading to the complications of osteomylitis (in five patients) and significant loss of joint function (in eight other patients). Clinicians must have a high index of suspicion when evaluating any hand injury and clenched first injuries of the hand should be treated by early adequate surgical debridement followed by IV penicillin given until operative cultures confirm or deny contamination withEikenella corrodens.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

We reviewed the efficacy of treatment techniques for femoral shaft fractures in our regional rural hospital setting. One hundred fifty consecutive primary femoral shaft fractures were managed at the Medical Center Hospital of Vermont during the period 1974 through 1979. The method of treatment was determined by the attending orthopedic faculty. Each case was evaluated at the time of initial hospital treatment, at 30 days postinjury, and at 1 year postinjury. Patient profiles, methods of injury, types of fracture, and associated injuries were reviewed. The choice of operative or nonoperative treatment in the first 30 days was the most important factor in the result at 1 year. Results were graded as ‘good’ if angulation was 0–5° in the A-P and/or lateral views; ‘fair’, 6–10°; and ‘poor’, > 10° or any need for supplemental surgery to achieve union. Shortening, infection, and thrombophlebitis were infrequent in this series.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Changes in calcium levels during and after resuscitation from severe shock were studied in 22 seriously injured patients who received an average of 21 blood transfusions and 26 mEq supplemental calcium. Total serum proteins (TSP), serum albumin (SA), total calcium (TC), and ionized calcium (CA++), were studied intraoperatively after the tenth transfusion and postoperatively at 5 hours, 15 hours, day 2, day 4, and during convalescene (day 25).The intraopertive TSP fell to 3.7 gm%; the TC and Ca++fell to 7.2 mg% and 1.4 mEq/L. The TSP and SA remained low throughout day 4 (4.8 and 2.6 gm%); the TC was also low on day 4 (7.5 mg%), whereas the Ca++rose to normal (2.1 mEq/L) by day 2. The severity of hypocacemia paralleled the hypoproteinemia, the number of transfusions given during resuscitation, and the duration of shock; paradoxically, hypocalcemia correlated inversely with Ca++supplementation of blood transfusions during resuscitation, suggesting increased extravascular Ca++flux with more severe shock. Further studies in comparably injured patients are needed to identify the concomitant responses of the calcium homeostatic factors such as parathormone in order to help identify the optimal role of calcium manipulation during resuscitation from hypovelemic shock.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Acute ethanolism in automobile drivers is purported to be both protective and detrimental in susceptibility to injury from an accident. The potential influence of acute intoxication (serum ethanol > 100 mg/dl) on pattern and severity of injury, hospital course, and long-term outcome, including mortality, was examined in 182 consecutive automobile drivers requiring admission to a regional university trauma center during 1980. Significantly more drivers were intoxicated than not, 61% vs. 39%. Similarly, more than 75% of the intoxicated drivers were young males and more than 80% of the intoxicated drivers were felt to be negligent and at cause for the accident. However, in this series, the patterns and severity of injuries, hospital course, and late outcome were unaffected by the patient's blood alcohol level. Acute alcohol intoxication apparently neither protected nor hindered the response to injury in these motor vehicle drivers.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Patients with blunt abdominal trauma and fatal outcome during 30 years in a well-defined rural Swedish area have been analyzed. There were 127 patients. Several facts indicate that more severe trauma has been appearing more often during this period. The mortality rate has, however, been stable, but the patients have become older. More patients die from pulmonary complications than from the trauma itself. One very important development is the significant decrease in mortality among children.

ISSN:0022-5282    

出版商:OVID    

年代:1983

数据来源: OVID