摘要:

Systems for the quantitation of injury severity are crucial to the study of injury epidemiology, and to comparative evaluations of health care delivery in different regions, patient mixes, and environments. Existing anatomic injury severity scores suffer from subjectivity, and may be computed only at relatively high man-hour expense. In this paper we present an injury severity ranking system termed the Anatomic Index, derived from objective, observed probabilities of mortality, and computable from the same HICDA diagnostic codes widely available in hospitals and through software in hospital computer systems. Mathematic underpinnings of the method, theoretical consequences of underprediction and overprediction of mortality, and advantages of the new Index are presented.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

In fracture-dislocations of the cervical spine with associated injury to the supporting posterior elements, anterior interbody bone block or dowel fusion does not give sufficient stability to the involved area. Additional fixation using an H- or HH-ASIF plate has been employed over the past 2 years in 26 cases. All patients had achieved solid fusion of the involved region of the cervical spine without recurrence of the deformity. None has required additional external plaster fixation. In 21 patients with neurologic involvement, recovery (complete, marked, or partial) occurred in 14; there was no recovery in four; deaths in three patients were late and in two were not related to their operations.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Using normal human lymphocytes isolated by sedimentation and cotton column adherence, we report development of a reliable assay of immunosuppression of PHA-induced blastogenesis by serum from patients with burn injuries. These lymphocyte cultures contained both responder cells (subpopulationx) and regulator cells (subpopulationy). Lymphocytes isolated by gradient centrifugation on sodium metrizoate-Ficoll contained responder cells (x) but no regulator cells (y). Cultures of lymphocytes isolated by this method were stimulated by PHA but were not suppressed by the addition of patient serum. When lymphocytes were isolated by a cotton column adherence/Lymphoprep centrifugation-double separation, subpopulations (x) and (y) were isolated. We have established that both subpopulations were necessary for suppression to occur, and that (y) operates as the regulator of (x). Finally, by manipulating B cell and T cell populations isolated by nylon column adherence or AET rosette separation, we; have demonstrated that the regulator ability of subpopulation (y) is the result of B cell activation of suppressor T cells.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Thirty-two patients were operated upon for suspected vascular injury following penetrating wounds of the groin. This injury is not uncommon, the patients survive to reach the hospital, and they require aggressive management. Vascular damage was found in 23 of the patients; there were no deaths and only one amputation. Eighteen of the 23 who had vessel injury were in shock upon arrival at the hospital. Of those subsequently found to have no vessel damage, none was in shock. Pulses distal to the injury were noted in six of the 23 patients. Arteriograms performed and interpreted by the surgery residents were helpful but not completely reliable. The repaired vessel must be covered adequately with viable tissue. The one amputation was in a patient in whom there was insufficient tissue to cover the repaired vessel. We conclude that general surgeons should be capable of managing this vascular injury.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

We have previously described the protective effect of a lipoidal splenic factor (SF) against lethal endotoxemia in mice. Since this protective effect is also accompanied by significant antithrombotic changes, and since burn injury causes thrombosis and consumptive coagulopathy, it was postulated that SF decreased the severity of the burn wound. Swiss white mice were anesthetized with pentobarbital sodium and then burned on a depilated area of the lower back with a 2-cm diameter stainless steel weight at 95° for 10 sec. SF (10 mg/ kg) (n= 20) or an equal volume of saline (controls) (n= 13) was administered within 1 hour after thermal injury. Severity of burn injury was assessed by examination of hematoxylin and eosin-stained biopsies obtained 24 hours postburn by a grading scale of 0 (normal) to 4 (severe) depending on the degree of epidermal loss, coagulation necrosis, and inflammatory cell infiltrate. Average degree of burn severity was 1.10 ± 0.20 for SF recipients and 2.85 ± 0.27 for the controls (p < 0.001).

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

In our study of 262 hospitalized flame burn patients, serum hyperosmolality, defined as having at least two reported osmolality values greater than 310 mOsm/kg, was observed in 15 patients (6%). From this group, nine patients were found to have an osmolal discrepancy (reported serum osmolality minus calculated serum osmolality). All patients in this group had a burn surface area greater than 35% TBS. The discrepancy between reported osmolality values of two patients from this group, determined by freezing point depression and vapor point analysis, suggested that a volatile substance was contributing to the osmolality. Further analysis by gas chromatography revealed propylene glycol as the agent accounting for most of the osmolal discrepancy. The only exposure to this polyalcohol was from the topical antibiotic cream (silver sulfadiazine) used in their treatment.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

One hundred twenty-seven case reports of high-pressure injection injuries have been analyzed, and five patients of our own are reported. The injury usually occurs to young, working males, most often to their nondominant index finger. Without proper surgical intervention, the injected part often progresses to necrosis, debilitating fibrosis, and stiffness. The pathology is that of inflammation and foreign body granulomatous formation. Damage results from impact, ischemia resulting from vascular compression, chemical inflammation, and secondary infection. Recommended treatment has traditionally been early surgical decompression, removal of injected material, and antibiotics. There is some evidence that anti-inflammatory medication is of value. In the patients treated early with steroids and proper antibiotics, infection has not been a problem. We feel that treatment of these injuries should include: 1) Immediate, high-dose, parenteral steroids followed by high-dose oral steroids in tapered doses. Our present regimen consists of initial doses of hydrocortisone sodium succinate 100 mg intravenously every 6 hours until it appears that swelling and erythema have maximized and begun to diminish, then changing to oral prednisone 25 mg twice daily. Prednisone is then slowly tapered in 5− to 10-mg increments per day until stopped. If swelling, pain, and erythema begin to worsen, high-dose steroids are resumed and tapered again. 2) Extensive and complete surgical decompression and drainage of the injured part. 3) Appropriate broad-spectrum antibiotic coverage.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Thirty-four cases of rupture of the bladder due to blunt trauma of the abdomen are reviewed. Intraperitoneal rupture occurred in 41% of the patients: extraperitoneal rupture occurred in 59% of them. Thirty-five per cent of the patients with extraperitoneal bladder rupture sustained concomitant intraperitoneal visceral injuries. While repairing the extraperitoneal bladder rupture a routine laparotomy through a small incision over the linea semicireularis was helpful in discovering intraperitoneal injuries in patients previously assessed by the general surgery service and considered to be free of intraperitoneal pathology.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Burns due to hot tar present a difficult management problem because the tar is difficult to remove without inflicting further injury to the underlying burn. We have found the surface active agent polyoxyethylene sorbitan (Tween 80, Sigma, St. Louis, MO) or Polysorbate (Sigma), by itself or in combination with an antibiotic ointment (neomycin sulfate) to be a safe and effective means of tar removal.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The most common bite injury in the United States is that of the dog and is associated with serious social and economic problems. Our series of 61 dog bite patients shows a majority of them to be in children and of the face and neck. Our treatment protocol centers on copious saline pressure irrigation, meticulous wound and wound edge debridement, repeated copious saline pressure irrigation, adequate antibiotic treatment, and close postoperative monitoring. Two hundred fifteen dog bite wounds in 61 patients were closed with this regimen with only a single wound infection. This is a wound infection rate of 0.47% and a patient infection rate of 1.6%.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID