摘要:

Normal subjects and surgical patients were studied with a noninvasive canopy-spirometer system which provides prolonged measurements of gas exchange and pattern of breathing. Values for normal subjects agreed with published values. Twenty-nine patients undergoing uncomplicated elective operation had a mean preoperative minute ventilation of 3.44 $$ 0.84 L/min/m2, a Vo2of 0.132 $$ 0.022 L/min/m2, and Vco2of 0.105 $$ 0.017 L/min/m2, and the postoperative values on the third to fifth day were not statistically different. The ventilatory equivalent (V.E.co2) or the liters of air moved per liter $$ for the indication of levels of minute ventilation, which are excessive for the associated metabolic demands for gas exchange. Thirty-eight runs on 18 acutely ill surgical patients showed mean increases in minute ventilation of 85%; the associated increases in metabolism averaged 17%. Therefore, their V.E.co2increased from a normal of 31 $$ 6 to 50.7 $$ 8, indicating a sharp increase in dead space ventilation. The additional clinical information provided by the serial graphic presentation of V.E.co2supplements what is learned from successive numbers representing the trend in VD/VT.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Using a standardized laboratory rat model of burn wound sepsis, a regimen of once a day application of Silvadene has been found to be more effective, treatment than Sulfamylon or cerium-Silvadene. Delaying treatment following infection resulted in decreased survival. Possible reasons for difference in mortality are once-daily application, or perhaps a change in sensitivity between drugs and the infective organism (Ps. aeruginosa) over time.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

We have developed a new method for coupling the hemostatic capabilities of argon laser light with the mechanical advantages of a sharpened quartz blade using fiberoptics. Using the new laser-assisted scalpel, a series of symmetrical skin excisions was done in 20− to 30-kg pigs on one side and with electrosurgery on the other. The laser scalpel was superior in its hemostatic properties (p< 0.01) with no statistically significant difference in surgical speed. Take of split-thickness skin grafts was 90% in beds excised with either the laser or the electrosurgical device. Histologic sections showed less tissue damage with the laser-assisted scalpel than with electrocautery.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Povidone-iodine ointment is a widely used topical antimicrobial agent in thermally injured patients. In 17 patients with burns ranging from 4 to 85% TBSA this agent was applied to both partial- and full-thickness burns. Peak serum iodine levels in patients treated within 24 hours of injury ranged from 595 to 4,900 $mUg per dL. The amount of iodine absorbed was directly related to the size of the burn. Serum iodine levels continued to rise until the drug was discontinued and remained elevated for as long as 7 days after discontinuance. Iodine excretion was directly related to renal function. The highest serum and lowest urinary iodine levels were present in patients who developed renal failure. Thyroid function was not affected by drug usage. A proven cause-and-effect relationship between the elevated serum iodine attributed to the absorption of povidone-iodine- and metabolic acidosis, hypernatremia, and hyperosmolarity was not established. Close monitoring of the patient's fluid and electrolyte balance is imperative during drug usage. The drug is contraindicated in any patient with impaired renal function. The high serum levels of this inorganic ion imply potential toxicity, but clinical evidence of cell or organ toxicity is as yet undetermined.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Children with thermal injuries have an unusually high incidence of hypertension during the course of their postinjury care. This study investigates the activity of the renin angiotensin system during the postinjury period. Sustained hypertension occurred in three of 11 children studied. All three cases demonstrated markedly elevated plasma renin levels (>2IRU x 104). Two of five children with episodes of hypertension also demonstrated abnormally high plasma renin. No normotensive patients had markedly elevated renin levels. The mechanism directing elevated renin secretion may be related to changes in regional blood flow in addition to the stimulus of increased catecholamine activity. A markedly elevated plasma renin may be predictive of the development of hypertension.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

To investigate whether biochemical changes soon after injury could be used as a measure of its severity or to predict its outcome we have examined the relationships of an injury severity score, initial blood metabolite concentrations, and subsequent biochemical changes in 33 injured patients. At about 4 hours after injury severity was related directly to blood lactate, pyruvate, and alanine (p< 0.01), and inversely to blood ketone body concentrations (p< 0.05). In 19 patients the daily total nitrogen, histidine, and 3-methylhistidine excretion was measured for 7 days. Only total urinary nitrogen was related to injury severity; 3-methylhistidine was inversely related to initial ketone body concentration; and histidine excretion was related to initial lactate, pyruvate, and alanine concentration. It is concluded that certain early biochemical measurements are significantly related to the severity of injury, and thus may be of practical importance.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The hypothesis that wound trauma produces either selective or total organ cell population alterations in the quantities of lympho-myeloproliferative elements in the major hematocytopoietic centers was tested. Mice were subjected to a 4% body surface skin wound on the anterior dorsum; their tissues were assayed 24 hours later for their total cellularity and proliferative potential. In wounded mice, the marrow cellularity was significantly decreased but this did not result in lower stem cell (CFU-s) and progenitor cell (CFU-c and M-CFC) quantities. However, there were significant selective and total population reductions in cells responsive to T and B cell mitogens. Splenic cellularity and stem cell quantities in wounded mice did not differ from control-treated animals. However, there were both selective and total population reductions in splenic CFU-c and M-CFC. Wounding resulted in a greater splenic T cell response to phytohemagglutinin PHA, while the responses to concanavalin-A (CON-A) were similar to controls. The splenic B lymphocyte population was specifically increased. Wounding resulted in a significant thymic hypocellularity. This was mirrored by a selective decrease in M-CFC and a total cell population reduction in response to T cell mitogens.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The pathophysiologic mechanism of fat embolism syndrome (FES) has been thought to depend on mechanical blockage of capillaries by fat emboli or on the toxic effect of free fatty acids on the capillary endothelium. Aggregation of platelets, microembolism, disseminated intravascular coagulation, and vasoactive amines are considered to be involved. The question of why some patients develop fat embolism while other patients with similar injuries do not remains to be solved.Blood tests in ten patients who developed FES and their reaction to stress were compared to the same tests in ten patients with similar injuries without FES at least 1 year after trauma. The following were measured: blood Hb, leucocytes, platelets, protein and lipid electrophoresis, ACTH, cortisol, TSH, GH, insulin, glucose, NEFA, certain coagulation and fibrinolytic studies, alpha, antitrypsin, and antithrombin III. The platelet values, especially after stress, and P+P values were higher in the FES-patients. The alpha-beta lipoprotein ratio was lower and the blood glucose values were higher in half of those FES-patients in whom a diabetic heredity was discovered. The U-catecholamines were also somewhat higher in the FES-patients. Disturbances of the lipid and carbohydrate metabolism as well as a high platelet count and high P+P values may predispose to thrombosis and DIC. More numerous petechiae in Rumpel-Leede's stasis test in fat embolism patients suggest increased capillary fragility. Low growth hormone values in FES-patients and a different cortisol reaction to stress compared to control patients suggests a disturbed neurohumoral regulation in FES.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Plasma fibrinogen chromatography and other relevant determinations of factors of known importance in thrombus production and dissolution were done serially in 19 hospitalized burned patients. The findings indicate that the coagulation mechanism was chronically activated and that, judging from the observed, sustained elevation of circulating high molecular weight fibrin (ogen) complexes, intravascular clotting was occurring at a pathological, if variable, rate. In patients older than 50 years of age, a relatively impaired thrombolytic response was also found; the latter finding is of special interest, as it provides biochemical substantiation for the well-recognized clinical proclivity of elderly burn patients to thromboembolic complications.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID