摘要:

The purpose of this study was to examine the financial impact of assault-related penetrating trauma. We specifically reviewed hospital charges and reimbursement data. Two hundred eleven patients were identified from our Trauma Registry in a 4-year period: 108 with firearm injuries and 103 with injuries related to cutting or piercing instruments. Assault-related penetrating injuries generated more than $2,000,000 in hospital charges. Sixty-seven percent of this amount was incurred by patients who had no source of third-party payment. Reimbursement covered only 30% of charges. There were no differences in demographics, procedures, or in insurance status, mean charges, and unpaid balances between patients directly admitted and those transferred from other hospitals. Financial losses incurred by community hospitals from the care of penetrating injuries are substantial, and must be borne by cost shifting or other strategies. No evidence of “dumping” was found among this group of patients. The specter of injury caused by intentional violence extends beyond urban trauma centers, and has a serious negative financial impact on community trauma centers.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A computerized data base identified 277 patients with violence-related ocular injuries seen during 16 months in an inner-city hospital. They constituted 35% of all patients with ocular injuries during the study period. Their demographics and ocular findings were analyzed. One hundred sixty-seven patients (60%) were black males, 60 (22%) were white males, and 50 (18%) were females (mean age, 29 years). The orbit was injured in 125, the retina/choroid and vitreous in 79, and the optic nerve in ten. Seventeen had penetrating ocular injuries. Nineteen eyes (7%) lost light perception. One hundred forty-six (53%) patients had associated non-ocular injuries, mostly facial fractures. Bludgeons and guns were the weapons most commonly used; theft was the most common motive; drugs and alcohol were prominent in 35 cases. One hundred thirty-three (48%) patients were hospitalized for a mean of 5.5 days and an approximate cost of $975,089. Conclusion: the human suffering and economic impact of violence-related ocular injuries are significant.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We examined the determinants of outcome following sharp penetrating chest trauma (SPCT) in Cape Town, South Africa. During a 6-month period, 248 nonsurvivors (comprising 231 prehospital and 17 in-hospital deaths) and 474 survivors admitted to the Groote Schuur Hospital Trauma Unit were located. Most (77%) of the deaths resulted from cardiac or great vessel injuries. An unexpected finding was that in 47 (19%) of the prehospital deaths, the only injury at autopsy was a unilateral lung wound. There were no deaths in the 442 patients with this injury admitted to the hospital. The survival rate following equivalent injuries was unexpectedly better in patients from poorer socioeconomic areas, possibly because of increased use of private transport to reach the hospital. The key to improved outcome after survivable SPCT lies in rapid transportation to adequate emergency care by the quickest available means.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Previous work has implicated both neutrophil-endothelial cell (PMN-EC) adhesion and PMN priming (enhanced superoxide production following activation) in the development of postinjury adult respiratory distress syndrome (ARDS) and multiple organ failure (MOF). CD11B, a member of the integrin family of PMN surface receptors, has been alleged to have a prominent role in these inflammatory PMN-EC processes. The purpose of the present study was to test the hypothesis that CD11B-mediated PMN-EC adhesion is necessary for endotoxin (LPS)-induced PMN priming. Human neutrophils, isolated by Percoll gradient centrifugation, were exposed to LPS (100 ng/mL). At fixed times over 120 minutes (a) superoxide following fMLP activation (i.e., priming), (b) PMN-EC adhesion, and (c) expression of CD11Bwere assayed. Superoxide production was measured by cytochromecreduction, PMN-EC adhesion with indium-labelled PMN adherence to human umbilical vein endothelial cell (HUVEC) monolayer cultures, and CD11Bexpression with fluorescent labelled anti-CD11B(60.1) antibodies. The PMN-EC adhesion was biphasic, with an early maximum at 15 minutes followed by a nadir at 60 minutes and secondary rise through 120 minutes of LPS exposure. CD11Bexpression changed dramatically in temporal association with early PMN-EC adhesion, but the secondary increase in adhesion was associated with only a mild rise in CD11Bexpression. PMN priming increased after a latency of 15 minutes to a maximum of 800 nmol/106cells/min after 60 minutes of LPS exposure. The role of CD11Bin PMN-EC adhesion and PMN priming was further investigated with CD11Bblockade using specific monoclonal anti-CD11Bantibodies at times of maximum priming and adhesion (i.e., 15 and 90 minutes of LPS exposure). CD11Bblockade dramatically reduced adhesion at both 15 and 90 minutes, but had no effect on the priming of PMNs exposed to LPS. In summary, the kinetics of LPS-induced CD11Bexpression correlate temporally with PMN-EC adhesion, but not with the induction of PMN priming. Thus, although CD11Bmay have an important role in LPS-induced PMN-EC adhesion, CD11B-mediated adhesion is not required for PMN priming.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Pentafraction (PF), a solution of biodegradable hydroxyethyl starch macromolecules with molecular weights of 10 to 100 x 104daltons, has been shown to minimize tissue edema by sealing interendothelial clefts at the capillary level. The effect of PF on ischemia-reperfusion-induced compartment syndrome was studied. Ten rabbits underwent bilateral femoral artery occlusion following ligation of branches from the terminal aorta to the popliteal artery. After 7 hours of ischemia, reperfusion was established with heparinized polyethylene shunts. Experimental animals (n = 5) received PF and control animals (n = 5) received normal saline (NS) as an intravenous infusion (30 mL/kg) for 1 hour, beginning 10 minutes after shunt placement. During reperfusion, anterior compartment pressure was continuously monitored in the left lower extremity. To quantitate oxidative metabolism, triphenyltetrazolium chloride (TTC) reduction (micrograms of TTC per milligram of protein) of tibialis anterior muscle from the right lower extremity was measured at femoral artery occlusion, 7 hours of ischemia, and 2 hours of reperfusion. In the NS group, anterior compartment pressure significantly increased from the end of the ischemic interval, 10.8 ± 4.14 to 36.4±9.9 mm Hg and 44.6±15.4 mm Hg, after 1 and 2 hours of reperfusion (p< 0.007) compared with the PF group, which did not change significantly, 10.6±2.6 to 11.4±12.9 mm Hg and 7.4±2.8 mm Hg, after 1 and 2 hours of reperfusion (p< 0.67). After 1 hour of reperfusion, the anterior compartment pressure of the NS group was significantly greater than that of the PF group (p< 0.009) as well as after 2 hours of reperfusion (p< 0.007). The TTC reduction following 2 hours of reperfusion increased significantly to 0.153±9.76 μg/mg in the PF group compared with the NS group, 0.006±1.34 μg/mg (p< 0.02). We conclude that the pentafraction of hydroxyethyl starch inhibits the increase in compartment pressure that follows prolonged severe muscle ischemia in this rabbit hindlimb model of skeletal muscle ischemia.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The production of free oxygen radicals by polymorphonuclear cells (PMNs) was studied in 25 patients after blunt trauma. Superoxide generation significantly increased immediately after trauma and returned to normal soon after the event. Patients were subsequently divided into two groups: those who developed sepsis and those who did not develop infectious complications. Superoxide production by intact PMNs following stimulation by three different stimulants was initially not different in trauma patients who developed sepsis. Follow-up showed an increase in superoxide production when infection complicated the course of trauma patients. Further studies were performed in a cell-free system containing cell membranes and cytosol from patients or healthy controls. No difference in the production of superoxide was found when membranes from trauma patients or controls were mixed with cytosols from controls. When cytosols from patients were mixed with membranes from controls, a significant increase in superoxide production was observed in the group that developed sepsis. Immunoblotting analysis of two protein components of the cytosolic portion of the NADPH oxidase, p47 and p67, were done. The increase in quantity of p47 correlated with the increase in superoxide production during sepsis, and thus may be the major contributor to the high activity.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Thirty-seven ventilator-dependent blunt trauma patients (ISS 36±15) were randomized at 24 hours after injury to receive parenteral (TPN) (n = 15), enteral (TEN) (n = 12), or parenteral plus enteral (PN/EN) (n = 10) nutrition. The TEN and PN/EN patients had endoscopically placed transpyloric feeding tubes. Patients who had nutritional complications were two TPN (13%), three TEN (25%), and five PN/EN (50%). Enteral complications were tube occlusion (two), failed duodenal intubation (one), patient extubation of feeding tube (one), gastric reflux (two), and abdominal distention (two). Mortality rates were not different between the groups, but were significantly related to the nutrition-associated complications (p= 0.01): four deaths in ten (40%) with complications and one death in 27 (3.7%) without complications. All four deaths associated with complications occurred in the four with gastric reflux or abdominal distention. No deaths occurred in the other 18 TEN or PN/EN patients (p= 0.0001). Of the four deaths, three were associated with ARDS and respiratory infection (75%). Conclusions: In mechanically ventilated blunt trauma patients, endoscopic transpyloric tube placement and feeding has a substantial failure rate (36%). Intolerance to duodenal feeding has a remarkably high mortality (100%) in patients in whom gut dysfunction may be a manifestation of injury severity or directly affect survival.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Injuries of the inferior vena cava (IVC) require prompt and definitive action. To evaluate our current management strategy, we reviewed 38 patients with IVC trauma treated from 1983 through 1990. Sixteen were injured by gunshots, eight by stabs, and 14 by blunt mechanisms. Thirty of the 38 survived (79%). All were awake on presentation, although 45% were hypotensive (systolic blood pressure

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The renin-angiotensin axis has recently been called the source of disproportionate splanchnic vasoconstriction during shock, and blocking this axis decreased gastric stress ulceration during swine cardiogenic shock. The present study tested whether the angiotensin converting enzyme inhibitor captopril would prevent stress ulceration when given after the onset of canine hemorrhagic shock, and whether any detrimental effects would result from enhancing splanchnic perfusion with captopril during hemorrhagic shock. We found that captopril treatment was associated with a decrease in gastric mucosal injury and with a marked decrease in systemic acidosis. Captopril enhanced blood flow to the small intestine, pancreas, liver, and spleen, but not flow to the stomach, during shock. Following the reinfusion of shed blood, the captopril-treated animals had decreased mean blood pressures and increased heart rates compared with untreated animals. We found captopril alleviated the stress ulceration produced by canine hemorrhagic shock, but concluded that the likely mechanism was alleviating systemic acidosis through enhanced perfusion of other viscera rather than a specific enhancement of gastric perfusion.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A canine model was used to test the hypothesis that critical intracompartmental pressure leading to ischemic muscle necrosis is linked to diastolic blood pressure. Twenty adult dogs were subjected to an infusion of autologous plasma into the anterolateral muscle compartment of the left hindlimb to create an elevation in compartment pressure. There were four experimental groups of five dogs each. In group I, the compartment pressure (CP) was maintained at the animals' diastolic blood pressure (DBP); in group II, at 10 mm Hg less than the DBP; in group III, at 20 mm Hg less than the DBP; and in group IV, at 30 mm Hg. The pressure was measured continuously in the proximal, central, and distal segments of the compartment during an 8-hour period. Immediately postoperatively, and, on the first, fourth, seventh, and fourteenth days one animal from each group was killed. The tibialis cranialis muscle was then removed and analyzed using light and electron microscopy. The critical pressure threshold for ischemic muscle necrosis was found to be 20 mm Hg less than the diastolic blood pressure.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID