摘要:

During a 33-month period, 40 multiply injured patients underwent 43 Brooker-Wills interlocking intramedullary nailings (BWIIN) for femur fractures in the setting of a Level I trauma unit. There were 12 open fractures (28%), 66% of the closed fractures underwent BWIIN within the first 24 hours of injury, and 33 fractures (77%) had comminution of Winquist-Hansen Type II or greater, and either static or dynamic locking techniques were used in 38 (88%) of the cases. There were three intraoperative technical problems. The estimated blood loss and operative times were consistent with other reported series for interlocking nailing techniques. The average followup was 65 weeks. Only one fracture went on to nonunion. There were no problems with angulation or rotation. One patient had 1.5 cm of shortening. There were four major (9%) and four minor (9%) complications. Rod removal was successful in 17 of 18 cases. Mechanical failure (deformation and/or fracture) of the proximal end of the rod was found in four (22%) of the extracted nails and caused failure of removal in one. The Brooker-Wills nail is a versatile device which can be used to treat complex fractures of the entire femoral shaft in acutely injured patients.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Cerebral and systemic metabolism of oxygen, glucose, lactate, pyruvate, beta-hydroxybutyrate, acetoacetate, and amino acids were studied in 27 comatose patients during the first 7 days after a head injury. Systemic oxygen consumption was elevated initially and gradually returned toward normal over the week of study. In contrast, cerebral oxygen consumption was depressed and decreased further over the week of study. Cardiac output and cerebral blood flow were increased with respect to systemic and cerebral metabolic requirements, and remained elevated for the entire week of study. Systemic hyperglycemia and lactic acidosis were present. The injured brain often made a sizeable contribution to the lactic acidosis. The arterial concentrations of pyruvate, beta-hydroxybutyrate and acetoacetate were low. The early postinjury arterial amino acid profile was typically an increased level of alanine, taurine, glutamic acid, and a reduced concentration of valine, leucine, isoleucine, threonine, serine, ornithine, and arginine. At 3—4 days postinjury, as the early abnormalities were returning toward normal, glutamine, lysine, phenylalanine, tyrosine, and methionine became elevated. These late increases in amino acids occurred at the time of the peak in plasma catecholamine concentrations. The net cerebral flux of amino acids followed the same general pattern of evolution over time as did the arterial concentration of amino acids. On days when the availability of the individual amino acid was increased, the net cerebral flux tended to be positive; when the availability was decreased, the net cerebral flux was zero or there was a net efflux of the amino acid. There was a significant linear relationship between the arterial concentration and the net flux of 13 of the 17 amino acids studied. Unlike the fasting state in normal man, in which beta-hydroxybutyrate and acetoacetate are important metabolic substrates, cerebral metabolism after head injury is almost totally dependent upon the aerobic and anaerobic metabolism of glucose. This is at least in part due to injury-induced limitations in the variety of substrates that are available for the brain to extract.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

in the production of colony-stimulating factor (CSF) and the proliferation of granulocyte-macrophage stem cells (CFU-GM), and overwhelming sepsis is often associated with leukopenia. The underlying mechanisms accounting for these granulopoietic defects are poorly understood, but the fact that postburn serum has been shown to inhibit CSF production suggests that a humoral factor or factors may play a role. Previous work has demonstrated that plasma levels of lactoferrin (LF), a known inhibitor of CSF production, are elevated following burn injury. To determine if LF is responsible for serum-mediated inhibition of CSF production, serial plasma levels of LF were measured in 18 burn patients using an enzyme-linked immunoabsorbent assay (ELISA). LF was elevated within 24 hours of injury and was associated with an absolute granulocytosis which rapidly declined, reaching a nadir at postburn days 3 through 5. Postburn serum, especially when collected during the first 24 hours following burn injury, inhibited in vitro CSF production by normal human peripheral blood mononuclear cells. Pre-incubation of postburn serum with an LF antibody restored normal CSF production. These data suggest that LF may play an important role in the regulation of postburn granulopoiesis.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This study was done to determine if a single drug, mezlocillin (Mezlo), is as safe and as effective as combined clindamycin (Clind) and gentamicin (Gent) in the treatment of penetrating abdominal wounds. One hundred seventy-three patients received either Mezlo or Clind/Gent combined therapy as assigned by computer-generated randomization. Of these, 147 patients were evaluable. Of 73 patients treated with Clind/Gent the mean duration of hospital stay was 8.9 ± 4.0 days. Infectious complications developed in 18 patients of whom five failed to respond promptly, but only one required change in therapy. Of 74 patients treated with Mezlo, the mean duration of hospital stay was 9.1 ± 5.0 days. Infectious complications occurred in 17, in whom four patients failed to eliminate their infections, and two needed changes in antibiotic therapy. None of the patients in either antibiotic group failed because of Enterococcus or Pseudomonas infections. There were no deaths. Twelve isolates of Bacteroides were found in peritoneal fluid cultures and all these patients had colon injuries. The overall therapeutic response was excellent to good in 94% on Clind/Gent and 93% on Mezlo. Azotemia developed in one patient on Clind/ Gent and one on Mezlo but no other adverse reactions occurred. The differences shown between the two groups were not statistically significant. We conclude that a single drug mezlocillin is as safe and as effective in the treatment of abdominal trauma as combined clindamycin and gentamicin.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Previous studies have shown that the application of electric fields to the damaged mammalian nervous system is efficacious in promoting regeneration of peripheral nervous system axons. The present experiments were undertaken to determine whether exogenously applied electric fields can induce regenerative responses in the damaged mammalian central nervous system (CNS). In these studies, chronically delivered direct current was applied to the optic nerve, orienting the cathode distal to the lesion site. Histologic analyses at 3 weeks revealed that the damaged optic nerve did exhibit a regenerative response following treatment. We believe that this represents the first report of regenerative effects on the mammalian visual system using chronic DC electric fields, and we suggest that such galvanic treatment may be used alone or as an adjunct to promoting regeneration of the injured mammalian central nervous system.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

One hundred complex femur fractures were treated with the Grosse-Kempf interlocking nail and 35 were treated with the Wagner external fixation device. Retrospectively, we analyzed the results in the two groups to determine specific indications for the future use of these nails. The Grosse-Kempf nail, although a technically demanding procedure, achieved excellent overall end results in comminuted closed fractures, and in Type I, Type II, and some Type III open fractures after appropriate wound care. We found that the Wagner apparatus was a simple, easy device for obtaining initial fracture stabilization in contaminated Type III-B and Type III-C open fractures. It does, however, require substantial postoperative care; four cases required secondary intramedullary fixation. We found a high infection rate with secondary reamed intramedullary nailing after initial stabilization with the external fixat

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The results of 12 operatively treated displaced stress fractures of the femoral neck in young male adults are reported. The mean age of the patients was 19.8 years (range, 19—24 years) and the mean followup period 4.0 years (range, 1—9 years). Sliding hip compression screw was used in ten cases, Jewett nail in one and 130° angled AO-plate in one case. Aseptic necrosis (AN) of the femoral head developed in five cases treated by sliding hip compression screw. It was correlated with increased operative trauma in four patients: open reduction in two, reoperation in one, and osteotomy in one case. Nonunion developed in three cases and it was combined with AN in two cases. In six cases the results were acceptable, but for the last three patients the followup period was only 1—2 years.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

To assess the utility of a routine pelvic X-ray in resuscitation of blunt trauma patients, 669 patients were studied prospectively over a 2-year period. One hundred twelve patients (16.7%) had positive pelvic X-rays (PPX). When compared with the negative pelvic X-ray group (NPX), the PPX group had a significantly higher mean Injury Severity Score, 24-hour mean requirement for blood and component therapy, and higher incidence of associated injury of chest and abdomen. Despite the higher injury parameters, the mortality between the groups was not significantly different. When compared with five standard resuscitative assessment variables, a pelvic X-ray performed as an additional predictor of injury severity and 24-hour blood requirement. A pelvic X-ray should be performed routinely in victims of blunt trauma as part of the early resuscitation X-ray protocol since a positive finding has immediate prognostic and therapeutic implications.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Mortality and morbidity from head trauma have been substantially reduced by improved prehospital care and aggressive diagnostic and therapeutic management. However, a substantial number of patients will require prolonged periods of hospitalization, intensive care, and ventilator support during their recovery, placing them at risk for infectious complications. Eighty-two such patients were reviewed during a 30-month period at a Level I trauma center. Forty-one patients (50%) developed at least one infectious complication. The most common source was respiratory, occurring in 34 patients relatively early (average, 3.2 days) in their hospital course. The severity of head injury and presence of coexisting thoracic trauma correlated statistically; administration of prophylactic antibiotics and corticosteroids did not in the development of infectious problems. Only three patients died as a result of sepsis, indicating that early recognition and prompt treatment may control the severity of infectious complications.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The hospital or medical examiner records of 75 victims of traumatic aortic rupture (TAR) were reviewed retrospectively. Among the 75 victims, 51 (68%) died at the scene. Those dead at the scene had higher Injury Severity Scores, 59.3 ± 13.8, than those who survived to be hospitalized, 42.6 ± 13.3 (p<0.001). The mean age of victims dead at the scene was not different than the mean age of those who arrived alive at the hospital. The incidence of death at the scene was significantly higher for patients with head injuries (p<0.01), victims with a second intrathoracic injury (p<0.025), and patients with associated intra-abdominal injury (p<0.001) compared to those without these injuries. A second fatal injury occurred in 51 (41.2%) of victims who died at the scene.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID