摘要:

Forty-eight patients with supracondylar fractures of the humerus have been treated at St. Michael's Hospital in the past 10 years. Forty-six of the 48 were treated surgically. A comparison was made between the use of standard AO (ASIF) plates with a pre-contoured plate especially designed for the distal humerus. The results of this comparison suggested that the specially designed plate provided superior fixation and better anatomic restoration of the distal humerus. Anatomic reduction, rigid fixation, and early surgery provide the best results.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Although the evaluation of acute or recurrent dislocations of the glenohumeral joint (GHJ) using routine radiography, specialized views, arthrography, and computed tomography (CT) has been extensively studied, methods of evaluation and osseous pathology of chronic unreduced GHJ dislocations are not well documented. In order to define such methods and pathology, we studied nine patients with chronic (greater than 6 months) unreduced anterior, posterior, superior, or central dislocations as well as one patient with a chronic rotator cuff injury; and seven scapular specimens, six with matching humeral specimens, with osseous abnormalities similar to those in the patients. We examined 15 additional scapular specimens with evidence of subluxation secondary to chronic rotator cuff injury. Standard, reformatted, and three-dimensional (3D) CT techniques were used to evaluate both the patients and the specimens.Our results indicate that characteristic alterations occur in the scapula and humeral head that are far more extensive than the classic Hill-Sachs, Bankart, and trough lesions. Such alterations occur at sites of osseous contact between the malpositioned humerus and scapula and are modified owing to prolonged adjustments made by the patients in an attempt to increase GHJ motion. Although routine radiography and specialized views are of some value, standard and 3D CT provide a more accurate analysis of the location and extent of the bone abnormalities and, as such, should be employed, particularly in the evaluation of patients in whom surgery is being considered.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Studies of trauma patients at clinical facilities commonly are flawed because nothing is known about kinetic or other energy forces causing injuries, and analysis may be limited only to inpatients, with no knowledge about those not injured, those with injuries not requiring treatment, those seen only in the emergency department, or those who died at the scene. Such problems are exacerbated in studies from trauma centers, whose populations reflect additional triage. Where alcohol is involved, acute intoxication may cause erroneous AIS, ISS, and Glasgow Coma Scale ratings based on initial patient assessment. Also, selective differences in frequency of testing for alcohol among different categories of patients can alter results.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Mild brain injury accounts for a substantial proportion of all persons admitted to a hospital for brain trauma, yet the amount of information on the epidemiology of this problem is quite sparse. Data on mild brain injuries for San Diego County residents injured in 1981 were analyzed for incidence, external cause, prehospital factors, diagnoses, alcohol use, and in-hospital treatment costs.More than 80% of all San Diego County residents hospitalized for an acute brain injury had a mild uncomplicated brain injury: a rate of 130.8 per 100,000 per year. Three quarters of these had an ER Glasgow Coma Scale of 15. Rates are twice as high for males compared to females, with peak occurrence for males at ages 15—19 years. More than 40% of mild brain injuries are caused by motor-vehicle-related events. The most common diagnosis was concussion (80%) or other intracranial injury (14%). Median length of hospital stay was 2—3 days and depended on brain injury diagnosis or Glasgow Coma Scale. Although less than 30% of those aged 15 years and older were blood tested for alcohol, two thirds of those tested had a level of 100 mg% or higher. In-hospital treatment costs for concussion or other mild intracranial injury for San Diego County residents exceeded six million dollars in 1981.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The acquisition of venous access with the potential for massive volume infusion can be a major determinant in the survival of a critically injured patient. A percutaneously placed 8.5 Fr common femoral vein catheter (CFVC) was inserted in 366 patients in whom upper extremity veins were unavailable or inadequate for volume resuscitation. Flow rates were further maximized by replacing standard intravenous tubing with genitourinary irrigating tubing (GIT). Infusion rates of up to 1,622 cc/minute (one liter in 37 seconds) of lactated Ringer's solution were achieved in this group of patients with a mean Trauma Score of 9.3 and a mean Injury Severity Score of 32.1. Although 90% of trauma patients can be managed with a peripheral vein catheter, venous access in patients with the potential need for massive volume infusion can be achieved in a rapid, safe, and efficient manner using the CFVC in conjunction with the GIT. We conclude that this system can be used effectively in trauma patients with hemodynamic instability, unavailable or inaccessible upper extremity veins, suspected cervicothoracic major vascular injury and when massive volume or blood replacement is anticipated.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A series of experiments was conducted to clarify the effect of intravenous administration of lidocaine on brain water content, local cerebral blood flow (lCBF), and neural recovery in brain injury induced by exposure of the cat's cerebral surface to the air. The injury produced ischemia and edema in the cortex and white matter without direct damage of the cortex. Lidocaine (3.0 mg/kg) was given intravenously for 30 minutes immediately after air exposure and thereafter at the rate of 2 mg/kg/hour. Twelve hours after exposure, lidocaine significantly suppressed cortical ischemia and edema; however, it had no effects in the white matter.The electrophysiologic activities of the cortex and white matter which were assessed by the direct cortical response and somatosensory evoked response were significantly preserved by lidocaine compared with nontreated animals.The results of this experiment demonstrate that intravenous lidocaine has a significant beneficial effect on cortical ischemia and electrophysiologic activities of the cortex and white matter in injured brain.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Age-related limitations of physiologic reserve in burned children make adequacy of intravenous fluid resuscitation critical. To quantify fluid requirements, the medical records of all children admitted to the Army Institute of Surgical Research from 1980 to 1986 whose weight was 25 kilograms or less and burn size was 25% or greater were reviewed to quantify fluid requirementsForty-three children ranging in age from 1.5—108 months (&OV0335; 26 ± 22 m), with 25–89% total body surface burned (TBSB) (&OV0335; 41.7% ± 14.6%), met inclusion criteria. The average total volume of fluid received during the first 24 hours was 6.3 ± 2.2 cc/kg/% TBSB. The net volume of resuscitation fluid, total volume less the calculated maintenance fluid requirements, was 3.91 ± 2.2 cc/kg/% TBSB.Univariate analysis and linear regression of independent variables including age, weight, per cent full thickness, and inhalation injury revealed each had no significant influence on the volume of resuscitation.We recommend supplying maintenance volume and initiating burn resuscitation at 3 cc/kg/% TBSB.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This study was performed in order to test the hypothesis that abdominal computed tomography (CT) can assist in the decision to perform laparotomy in children following blunt trauma to the abdomen. Three hundred forty children with blunt abdominal trauma underwent evaluation with CT. Abdominal injuries were detected in 84 children (25%). These included: 75 injuries to solid viscera in 60 patients (30 splenic, 29 hepatic, 13 renal, and three pancreatic); four injuries to hollow viscera (three small bowel transections, and one rupture of the urinary bladder); and 23 skeletal injuries (21 fractures of the pelvis, and two lumbar spine subluxations). Injury to solid viscera was categorized as minor in 32 (43%), moderate in 18 (24%), or severe in 25 (33%) according to an assessment of the percentage of parenchyma involved. Hemoperitoneum was detected in 42 patients, and characterized as small in 18 (43%), moderate in nine (21%), and large in 15 (36%).CT was useful in establishing the location and extent of injuries, and in detecting the presence of blood or air in the peritoneal cavity. However, the extent of injury to solid viscera detected on CT did not correlate with the need for laparotomy. Of 46 moderate to severe anatomic injuries of the liver, spleen or kidney, only five (9%) required surgical intervention because of persistent bleeding or infection. Although laparotomy occurred more frequently in the presence of a large hemoperitoneum, only 6/24 (25%) with moderate to large hemoperitoneum required surgical exploration.This analysis confirms the usefulness of CT for detection of location and extent of injury in pediatric blunt abdominal trauma. However, the decision for laparotomy is not based on the extent of anatomic injury as shown on CT, but on the physiologic condition of the child.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

An analysis of 186 consecutive patients with anterior abdominal stab wounds in a 2-year period was carried out to assess the efficacy of serial physical examination as the determining factor for the need for laparotomy. Of 106 patients managed by clinical evaluation, the incidence of negative laparotomy was 0.9% and three patients (2.7%) had an “unnecessary” celiotomy. There were no missed injuries or delayed detection of intraperitoneal visceral trauma. The incidence of negative laparotomy among patients subjected to wound exploration ± peritoneal lavage (n= 41) was 2.4%, and 39 patients had mandatory laparotomy for evisceration, with a negative celiotomy rate of 20.5%. Our experience supports serial physical examination as a highly effective method of “selective conservatism” of anterior abdominal stab wounds. Mandatory laparotomy for evisceration needs further clarification.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Impairment of T-cell function is a consistent observation in burned patients. Concomitant with this impairment is an increase in serum factors which inhibit interleukin-2-mediated T-cell functions. These factors are heat labile and do not behave like endotoxins. Nonetheless, treatment of burned patients with endotoxin-neutralizing regimens of polymyxin B reduces the levels of these factors, suggesting that they are generated in response to endotoxin exposure. In addition to factors which inhibit I1–2 responses burn serum contains increases of circulating soluble, cell-free I1–2 receptors. However, the level of I1–2R is not altered by polymyxin B treatment and does not appear to be a direct result of endotoxin exposure. These observations suggest that multiple causes contribute to T-cell impairment in burned patients.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID