摘要:

The pulmonary entrapment of microaggregates, platelets, and white cells in stored blood is thought to contribute to abnormalities in lung function. Washing of red cells removes these potentially damaging elements. This prospective, randomized, double-blind study compares the pulmonary function of patients undergoing abdominal aortic aneurysmectomy who received either washed or unwashed red cell concentrates. Both groups received equivalent volumes of blood, albumin, and balanced salt solution during surgery. Postoperatively, no differences were observed in the physiologic shunt, Qs/Qt, pulmonary artery pressure, pulmonary vascular resistance, or effective dynamic compliance. The cardiac index at equivalent left ventricular filling pressures was the same. The results indicate that it is unlikely that microaggregates or other formed elements in stored blood lead to compromised pulmonary function.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The amputated hindquarters of adult female rats were infused with solutions of lactated Ringer's, Collins hypertonic renal perfusate, and dextran-dextrose on a washout and continuous basis. The perfusate was analyzed for energy compounds and breakdown products and the muscle tissue examined histologically. Intermittent perfusion or injection under pressure led to marked edema in a 4-hour period and was abandoned in favor of a system that perfused the part at 120 to 150 cm H2O. The model perfused with Collins gained an average of 1.35 gm, that with lactated Ringer's 2.35 gm, and that with dextrandextrose lost 2.35 gm. Pressure graphs of the various solutions indicated that the vascular bed reacts more physiologically to Collins solution and dextrandextrose than to lactated Ringer's. Histologic sections of the muscle biopsies confirmed this. The release of ATP and hypoxanthine with lactated Ringer's suggests that it is the most damaging of the perfusates. These findings support the results of the pressure graphs and histologic studies. A potential for replantation of amputated limbs that contain muscle when the cold ischemia time may exceed 6 hours is suggested by the data presented.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

It is well known that splenectomy causes immunologic impairment and increases susceptibility to infection; however, the time course of reticuloendothelial depression and of alterations in hepatic and pulmonary retention of injected lipid emulsion following splenectomy is not known. To determine this, rats were splenectomized and reticuloendothelial function evaluated at various intervals following splenectomy by measuring the intravascular clearance of131I-triolein gelatinized lipid emulsion. The intravascular clearance (T/2) and lung uptake of the lipid emulsion increased and hepatic uptake of emulsion decreased 4 to 8 hours following splenectomy. One day following splenectomy, although the T/2 appeared normal, the lung uptake was 1,123% higher and hepatic uptake was still 33% lower than control. The T/2 and hepatic retention returned to normal 2 days following splenectomy; however, the lung retention was higher than controls even 10 days following splenectomy. In another set of experiments, splenectomy was performed following which sepsis in rats was produced by cecal ligation and puncture. Ten hours following cecal ligation and puncture, the gangrenous cecum was removed and survival was measured over 5 days. The mortality rate in these animals was 57% (12/21) compared to 0% (0/8) in nonsplenectomized cecal ligated and punctured animals. These results suggest that splenectomy may not only have deleterious effects in terms of the host defense system, but may also cause prolonged pulmonary changes.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The correctness of the clinical diagnoses of all victims who died of an acute lethal injury of the trunk at the Department of Orthopaedics and Traumatology, Helsinki University Central Hospital in 1975–1976 was investigated. A clinicopathologic comparison on the injuries as of the time of death and severity of the trauma complex resulted in the following main observations: About 80% of all lethal injuries, 70% of the associated severe lesions, and 80% of the other more minor injuries were correctly diagnosed by clinical means with an overall accuracy of 74.5%. When victims were dead on arrival, 50% of the injuries were diagnosed by plain physical examination. When the patient died within 24 hours, 80% of the injuries were clinically diagnosed, and when the patient died between 1 and 7 days postinjury the rate was 90%. Injuries of the heart and great intrathoracic vessels, ruptures of the liver and spleen, as well as medullary contusions remained most often undiagnosed in patients who died within a few hours. Of all clinically diagnosed injuries, of which one was severe, 5.7% were not noted at autopsy.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Based upon the prior observation that drugs which reduce sympathetically induced lipolysis also reduce plasma volume loss following thermal trauma, it was postulated that the products of the metabolism of polyunsaturated fatty acids (PUFA) were the substances causing the plasma volume loss. The two major metabolic pathways for PUFA are cyclo-oxygenase transformation to form prostaglandins and lipoxygenase transformation to form fatty acid hydroperoxides. This latter pathway also produces the superoxide anion and hydrogen peroxide. To test the effects of alterations of these pathways of PUFA metabolism upon plasma volume loss, the effects of indomethacin (a cyclooxygenase inhibitor), orgotein (a superoxide dismutase), and catalase (an enzyme which converts hydrogen peroxide to inactive substances) were studied in anesthetized dogs receiving a 15% total body surface area third-degree flame burn. The results of this study showed that indomethacin did not alter postburn plasma volume loss, orgotein reduced early plasma volume loss but did not reduce continuing loss, and catalase reduced both early and continuing plasma volume loss.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Seven fractures of the neck of the talus were internally fixed using a lag screw inserted through the posterior tubercle. This followed closed reduction under fluoroscopic control in five cases with moderate displacement, whereas open reduction was performed in two cases with dislocation of the talar body. The fractures healed in 2 to 3 1/2 months. Clinical results, evaluated between 2 and 7 years after fracture, were excellent in three cases and good in four. Osteonecrosis of the talar body occurred in two cases: in one it was followed by revascularization without bone collapse; in the other it was followed by partial collapse of the body. Although the method described does not give full protection against osteonecrosis, it appears to have definite advantages over conventional methods of treatment.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

A retrospective study was carried out of 48 patients who underwent ankle arthrodesis for traumatic arthritis from January 1967 through January 1976. Following ankle fusion, the most common complaint was subtalar pain and the most frequent finding was limitation of subtalar motion (56%). Subtalar or triple arthrodesis was required in 12 patients, with good results in the majority of the cases. An infection rate of 22% was encountered, felt to be consequent to the failure to properly employ prophylactic antibiotics; which, when employed, were associated with less than 6% incidence of sepsis 69% of patients were improved from their status before ankle arthrodesis; 12% had come to belowknee amputation (three for resistant pain, two for chronic osteomyelitis, and one for vascular insufficiency). Fusion of the subtalar joint seems curative, and early mobilization of the subtalar joint by ankle fusion techniques that do not immobilize the entire foot may play a preventive role.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

138 patients with extradural hematoma have been analyzed in order to assess the factors influencing their mortality. Early diagnosis, based on the development of minimal clinical signs, and prompt treatment will lower the mortality rate. The 16% mortality rate in this series might be reduced to 11%, had there been no errors in management.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

A retrospective survey of the records of 327 patients with multiple injuries was carried out in order to establish the incidence of missed injuries and the reasons for diagnostic failures. Twelve per cent of the patients had an injury not diagnosed at the first examination. The most vulnerable group were motorcyclists in whom the incidence was 23%. Missed injuries tended to be grouped about the major joints. Factors which predisposed to an inadequate initial assessment were poor clinical routine, failure to interpret correctly certain physical signs, poor utilization of X-ray services and, above all, admission of these patients to nonorthopaedic wards.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The hemostatic efficacy of collagen fibers as a fleece hemostatic agent (CFH) is compared with the efficacy of three commercially available agents: collagen powder (Avitene), absorbable gelatin sponge, and oxidized cellulose. Identical quantities of the four materials were applied to identical multiple spleen incisions in five dogs; CFH and collagen powder proved three times as effective as the other two materials. CFH and collagen powder were then compared with regard to hemostatic efficacy, handling characteristics, and tissue reaction. Different weights of the materials were applied to multiple spleen lacerations in 12 dogs and spleen avulsions in 12 dogs. The hemostatic efficacy of the materials was similar, but CFH was superior with regard to handling characteristics and tissue reaction. Another experiment, with six pigs, showed that CFH can be successfully sutured as a patch to profusely bleeding lacerations of the spleen, liver, and kidney.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID