摘要:

In the last ten years, 22 patients with transection of the descending thoracic aorta were seen at the Ben Taub General Hospital. Five patients with massive left hemothorax died shortly after admission. Among 17 patients in whom proximal and distal control could be achieved, three died in the operating room; three died within 30 days of operation, and one patient died of sepsis more than 1 year postinjury: ten patients are longterm survivors. Partial pump bypass was utilized in six patients, and in one a heparinized shunt was used intraoperatively. Dacron tube grafts were used in 12 cases. and primary repair was accomplished in three. One patient was paraplegic on admission, and two others in whom this was not established before operation were found to have this complication postoperatively. One patient with an infected false aneurysm 1 year after operation underwent resection of the distal aortic arch and Dacron graft with extensive extravascular bypass procedures. Patients with transection of the descending thoracic aorta die if proximal control is not achieved before rupture of the hematoma. Successful repair of this injury requires aggressive diagnostic and surgical management.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

If uniform early diagnosis is accomplished, two thirds of patients with rupture of the proximal descending aorta seen at a primary trauma treatment center are potentially salvageable. Currently the survival rate is only one half of this optimum figure (31%).One third of 39 patients with acute rupture of the proximal descending thoracic aorta studied had lethal concomitant injuries and were unsalvageable.Twenty-six patients were potentially salvageable; twelve (46%) survived. Eight potential survivors (31%) died because their aortic rupture was not diagnosed or because it was not promptly diagnosed. Eighteen of the potentially salvageable patients (69%) underwent aortic repair; two thirds survived. Aortic rupture was uniformly diagnosed earlier in the more critically injured patients and thus they underwent aortic repair earlier. One half of the 12 patients in whom thoracotomy was instituted within 6 hours of admission survived; six patients who underwent aortic repair more than 6 hours after admission survived.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

A cooperative study between the Department of Otorhinolaryngology and the Highway Safety Research Institute of the University of Michigan was designed to study temporal bone fracture produced in cadavers subjected to realistic automotive impact situations. Utilizing sled and piston impact configurations frontal and parietal impacts were noted to produce ipsilateral and contralateral fractures of nine temporal bones in seven cadavers. The impact velocities varied between 18.1 and 25.0 mph. Using standard otologic microsurgical techniques, the temporal bones were dissected and numerous gross and microscopic injuries to middle and inner ear structures were found. The authors conclude that extensive comminuted fracture of the human temporal bone is seen with realistic crash situations of low velocity, and that lateral impact which produces a longitudinal fracture with a posterior fossa comminution is associated with disruption of the cochlea and facial nerve, as well as of middle ear structures. The classical transverse fracture of extensive skull trauma lies medial to these structures and does not involve the otologic contents of the human temporal bone. Associated brain and skull injuries are also described.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

A 3-year experience of intracranial pressure monitoring of head-injured patients with a fiberoptic system, and the basic mechanics of the system are discussed. In the overall study. 46 patients were monitored for up to 32 days. there were no infections. Thirty-three patients had elevated pressure, and 16 of these patients required treatment of their elevated pressure. The pertinent findings in intracranial pressure monitoring that may indicate the need for, and the response to, therapy for increased intracranial pressure are also presented. The data obtained from monitoring indicate that intracranial pressure monitoring can also be an aid in the attempt to determine the prognosis of the patient.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Peripheral nerve trauma has been a challenge to surgeons, with significant advances in the surgery of repair occurring in major wars. The standard method of treatment involving wide mobilization and end-to-end suture to close traumatic gaps in peripheral nerves has not produced consistently acceptable results, particularly with large gaps. However, with the recent development of microsurgical techniques and instrumentation, the method of interfascicular nerve grafting has been applied to selected patients with trauma problems of the peripheral nerve, by resecting and autogenous nerve grafting at staggered levels to distribute scar formation, followed by plaster immobilization for 3 weeks. Ten patients are reported, with motor nerve recovery ranging from M2to M4and sensory recovery, S2-S4 (See Table I), based on Seddon's classification (11).

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Six cases of traumatic rupture of the right hemidiaphragm are reviewed with emphasis on diagnostic features and operative treatment. In one (Case 6), a mass lesion was seen in the chest 2 years after the initial injury and was repaired through a right thoracotomy incision. There were no deaths. Of the five cases operated on soon after the initial injury, two were approached initially via right thoracotomy incisions and both required second incisions for injuries below the diaphragm. Three ruptures of the right hemidiaphragm were successfully repaired through laparotomy incisions without extension of the incision into the chest. Laparotomy is the preferred approach for rupture of the right hemidiaphragm during the acute phase, because exposure is adequate and life-threatening injuries below the diaphragm can usually be dealt with through the same incision.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

A group of 147 injured skiers seen in the emergency room of a midwestern hospital was studied. There were almost twice as many males as females, and lower-extremity injuries outnumbered upper-extremity injuries two to one. Leg injuries tended to occur in beginners whose bindings failed to release. Upper-extremity injuries were prevalent in better skiers whose bindings released properly. Frequent binding checks only slightly improved the likelihood of proper binding function.

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1977

数据来源: OVID