ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A group of 1,009 children less than 15 years of age and consecutively admitted to a Pediatric Trauma Center was used to compare outcomes with the adult (15-54 yrs) MTOS norm population using TRISS. Four pediatric age groups (0-1, 0-3, 0-8, 0-14 yrs) formed the study groups. TRISS analysis resulted in no statistically significant difference in predicted outcome between any of the four pediatric groups and the adult baseline group. There were only seven misclassified children (0.69%) with respect to survival/death outcome, indicating the usefulness of TRISS to characterize pediatric blunt trauma. In addition, TRISS was used to delineate the injury severity mix of the pediatric population. A TS less than or equal to 14 and ISS greater than 15 was found to serve as a useful definition of severity in this group of injured children.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Since /9-1,3-glucan is a common component of fungal cell wall, its detection might be useful in diagnosing invasive candidiasis. Not only endotoxin but /3-1,3-glucan activates proclotting enzyme contained in a conventional chromogenic limulus test (CCLT). Endotoxin activates this enzyme through factor C, while the /3-1,3-glucan activates through factor G. Since endotoxin specific test (EST) contains factor C, endotoxin would be quantified. By subtracting EST value from CCLT value, β-1,3-glucan would be quantified. We named this value Fungal Index (FI), and examined if it actually reflects the candidal infection. Ninety-two patients were tested for CCLT and EST prospectively. FI increased significantly in candidal infection (p<0.05) but remained low in GNR infection. Moreover, FI increased proportionally to the severity of candidal infection. Elevated FI decreased when antifungal therapy was successful. Thus FI was a useful index not only in the diagnosis of invasive candidiasis but also in the evaluation of antifungal therapy.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This paper reports a retrospective analysis of patients with serious yet substantially survivable injuries represented by ISS scores from 20 to 39 and whether or not survival was influenced by the use of helicopters. A review of 606 of these patients with blunt trauma was performed for the period from 1983 through 1986. When the group was evaluated there were 451 patients in the ISS cohort of 20-29 and 155 in the 30-39 group. The mean age was 30.5 years and 76% were males. A total of 259 patients were transported by ambulance and 347 by helicopter. Characteristics of the two groups were similar. The mean TS was 12.7 for ambulance and 12.1 for helicopter patients. Mean GCS was 10.4 in the ambulance group and 9.6 for helicopter patients. Overall the mortality for ambulance transported patients was 13% compared to 18% for the helicopter group. We conclude that there is no survival advantage in the helicopter transported group in an urban area with a sophisticated prehospital care system. Patients of rural origin deserve further study.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

During a 9-year period, 16 patients with a delay in diagnosis of an injury to the diaphragm after a penetrating wound were treated. The left hemidiaphragm was involved in 15 of 16 patients, and the delay in diagnosis from the time of arrival in the emergency center immediately after injury ranged from 16 hours to 14 years.In the patients in the Acute Group (delay of hours to days), three patients had diaphragmatic defects missed at the time of laparotomy, three patients had chest X-rays not immediately suggestive of diaphragmatic defects, two patients had false-negative lavages, and one patient treated elsewhere did not have a chest X-ray in the emergency room. In the patients in the Chronic Group (hernias presenting months to years after injury), four of seven patients had misreading of a recent chest X-ray or failure to have a chest X-ray performed during numerous return visits to the emergency center.Despite a variety of diagnostic maneuvers, these defects and hernias continue to be diagnosed after a delay. Careful review of early and late followup chest X-rays appears to be the easiest mechanism to avoid significant delays in diagnosis.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Previous studies have shown that severe sepsis after major trauma results in the reprioritization of release of hepatic acute-phase proteins (APP). They suggest competition for leucine for nutritional utilization may be responsible. To test this hypothesis, a branched-chain enriched (46.6%) amino acid mixture (BCAA) was administered on a prospective randomized basis with standard TPN therapy to 16 septic post-trauma patients. After sepsis was diagnosed, a randomized therapy (control-TPN or BCAA-TPN) was given for 12 days, or until death occurred. Total calories and amino acid nitrogen (N) administered were not different in the two groups (f-test) and q 8 h (347 study periods) amino acid clearances, urinary urea nitrogen excretion, muscle proteolysis from 3-methyl-histidine (3-MH) excretion, and standard indices of sepsis severity and hepatic function were measured, as well as platelets (PLAT), leucocytes (WBC), albumin (ALB), and six acute-phase proteins: C-reactive protein (CRP), alpha-1-antitrypsin (A1TRIP), fibrinogen (FIBRIN), alpha-2- macroglobulin (AMACRO), ceruloplasmin (CERUL), and transferrin (TRANS). Using Scheffe analysis of all contrasts the data showed: BCAA resulted in a fall in 24-hour urea N excretion (24.0 to 20.0 gm/24 hr) and in proteolysis (138 to 126 gm/24 hr) (p<0.0001). Prestudy CRP levels were all elevated, but compared to control where APP reprioritization occurred, over the initial 10 days of therapy BCAA patients had a more rapid fall in CRP with a more rapid rise in FIBRIN, TRANS, CERUL, ALBUMIN, AMACRO, and A1TRIP (allp<0.0001) relative to CRP. Also, the sepsis-reduced clearances of glutamine and glutamate, alanine, and proline were increased (p<0.0001) during BCAA even though urea nitrogen production was reduced (p<0.0001). The increase in leucine clearance with BCAA-enriched TPN was positively correlated (r2=0.601;p<0.0001) with the increase in the sum of all APP and ALB and was also associated with an increase both in FIBRIN and in platelets (p<0.0001). The BCAA-related increase in FIBRIN (9.1 to 11.9 mg/ml) occurred at the same time as a fall in prothrombin time (p<0.0001). BCAA-enriched TPN reduced proteolysis and amino acid catabolism and appeared to increase the levels of the more rapidly appearing anti-inflammatory and nutritional hepatic APP and formed coagulation elements in post-traumatic sepsis.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The simultaneous admission of nine youths to our institution following their ingestion of concentrated sodium hydroxide (which had been mistaken for wine) provided us with a unique opportunity to manage corrosive esophageal injuries ranging in severity from second-degree oral mucosal injury alone to full-thickness hypopharyngeal, esophageal, and gastric injury. The severity of injury was graded first on the basis of symptoms and physical examination of the mouth, and then in the operating room by rigid esophagoscopy. This procedure provided a logical approach to management.Three patients with second-degree oral burns required no surgery. Six patients required laparotomy with gastrostomy and/or chimney feeding jejunostomy, one required immediate esophagogastrectomy, and three required immediate total or subtotal gastrectomy. There were no deaths. Three patients have subsequently required esophageal replacement and three others have required repeated dilatations. At 2-year followup, all nine maintain their nutritional status orally, and all except for the previously mute patient can phonate.Ingestion of liquid lye requires a much more aggressive diagnostic and therapeutic approach than is currently recommended for ingestion of caustics in general. On the basis of our experience with these nine patients, we suggest the following for esophageal liquid lye injury: 1) early evaluation of the esophagus by esophagoscopy; 2) with esophageal burns, urgent laparotomy to assess gastric damage and gastrostomy to pass a string for subsequent retrograde dilatations; 3) adequate resection of stomach for gastric burns; 4) with deep esophageal burns, early esophagectomy.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Fourteen adult patients (mean age, 35 yrs) with 20-60% total body surface area (TBSA) burns (mean, 35%) were resuscitated using hypertonic sodium lactate (HSL: sodium=250 mEq/L). Plasma concentrations of atrial natriuretic peptide (ANP), arginine vasopressin (AVP), angiotensin II (A-II), epinephrine (E) and norepinephrine (NE) were measured on admission and for 7 days following burn injury.Serum sodium concentrations and osmolalities were lowest on admission, and were persistently elevated following HSL resuscitation. Plasma AVP levels were highest on admission and correlated with the size of the burn injury. Between days 4 and 5 plasma ANP levels rose while plasma AVP levels returned to normal. Plasma concentrations of AVP and ANP did not correlate with serum osmolality or serum sodium concentrations on admission or after HSL resuscitation. Plasma levels of A-II, NE and E were elevated throughout the 7-day period and were unrelated to the size of the burn.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Treatment of thoracolumbar spine burst fracture with a neurologically intact patient is controversial, with advocates of operative and nonoperative approaches. Of 404 patients in a prospective spinal trauma study, 21 had burst fractures, were neurologically intact, and had greater than 1-year followup. This group was analyzed to evaluate treatment with early mobilization using a thoracolumbar total contact orthosis. The average time in a brace was 6 months. Two patients had pulmonary embolus treated successfully with anticoagulants. No patient required subsequent surgery for increasing kyphosis or neurologic deficit. Change in K angle at followup was 4.6° (± 5.7) and change in anterior vertebral height was 6.1° (± 10). All patients had a satisfactory pain score and most individuals returned to full employment. It is concluded that it is not necessary to routinely treat patients operatively with burst fractures if they fulfill the following criteria: 1) neurologically intact; 2) kyphosis angle less than 35°; 3) other injuries do not preclude the use of a total contact orthosis; and 4) the patient is capable of understanding and cooperating with the treatment regime. These criteria are irrespective of the CT findings of posterior vertebral retropulsion and spinal canal narrowing.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We evaluated the efficacy and safety of fibrin glue (FG) made with highly concentrated human fibrinogen and clotting factors in achieving hemostasis of superficial and deep hepatic injuries. Experimentally produced hepatic injuries were produced in 12 adult mongrel dogs and hemostatically sealed with FG. Half of the dogs each received two penetrating hepatic injuries consisting of a large laceration and a deep stab wound through the liver; the remaining dogs underwent resection of a large segment of the left lobe of the liver. Hemostasis was achieved by applying FG into and over the bleeding wounds; hepatic arterial occlusion was not used. Complete hemostasis was achieved in all animals before skin closure. One dog from each group was re-explored and the liver specimens harvested for gross and microscopic examination at postoperative intervals of 12 hours, 24 hours, and 2, 3, 6, and 8 weeks. There were no cases of intra-abdominal infection, abscess formation, or bile fistulae. Histologic examination demonstrated a thickened capsule containing fibrous connective tissue and neovascular proliferation; there were no signs of local or systemic toxicity. One dog died on postoperative day 1 from rebleeding from the hepatic injury; all other dogs survived without complications. We conclude that FG provides effective hemostasis of superficial and deep hepatic injuries, and has good systemic and local compatibility. Its use in surgery for hepatic trauma may lead to less intraoperative blood loss and transfusion requirements, as well as a reduced need for major hepatic resection to control hemorrhage.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID