摘要:

Seventy consecutive surviving patients with pelvic fractures were reviewed to define those at high risk for intra-abdominal injury. Eleven (16%) had serious associated visceral injuries. Initial hypotension, Malgaigne and bilateral pubic rami fractures, and blood requirements exceeding 2,000 cc were suggestive of abdominal trauma.These high-risk patients should undergo diagnostic peritoneal lavage as an integral part of their initial management. If the lavage is negative, continued hemorrhage should be evaluated with angiography and nonoperative means of vascular control attempted before resorting to laparotomy.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Persistent ankle pain, swelling, and crepitus should suggest the possibility of osteocartilagenous lesions of the talar dome in some patients with ankle pain. Tomograms may be required to demonstrate their presence.Excision or excision and curettage of these lesions have been shown to provide a good result in 63%, and a fair result in 30% of the 31 cases that failed to respond to nonoperative treatment.Osteocartilagenous lesions of the talar dome appear to have a traumatic etiology. In the talar dome, what has been called osteochondritis dissecans, is, in most cases, a transchondral fracture.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

In the period 1970–1978, a mortality rate of 44% resulted in 45 patients who suffered major intra-abdominal venous injuries. An especially grave prognosis accompanied wounds to the inferior vena cava and the hepatic and portal venous systems. Management of damage to major veins presents several difficulties. Exposure is poor; veins tear easily when clamped or sutured; exsanguination can occur as rapidly as with arterial trauma; because of low intraluminal pressure, postoperative chances of thrombosis and occlusion are high; veins (unlike arteries) have no intrinsic vasomotor capabilities to halt bleeding. Finally, the misconception persists that venous wounds are less serious than comparable arterial injuries. Simple pressure by packs or hand often controls bleeding: otherwise clamps, balloons, hemostats, or ligation can be selectively chosen. Our experience suggests that atrial-caval shunting without prior identification and control of the bleeding site is doomed to failure.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Thirty-three peripheral arterial injuries were observed in 29 patients following blunt trauma. Motor vehicle accidents were the most common initiating event. The mechanism of injury was fracture or dislocation in 21 patients, acute traction on the extremity in five patients, and contusion in three patients. Pulses were absent distal to the site of arterial injury in all patients. Complete arterial disruption was documented in 19 arteries; intimal or intimal and medial tears were observed in 10 arteries. Four arteries were not surgically explored. If possible, debridement and primary anastomosis was the preferred method of revascularization. Saphenous vein interposition grafts were the second choice. Five amputations, four major and one minor, were required. Although patent vascular reconstructions may be uniformly achieved, long-term functional results are frequently affected by the duration of limb ischemia before revascularization, and concomitant injuries to bone, nerve, and soft tissue.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

A simple technique for assessing inpatient resource requirements is presented. Using this technique the demands on various hospital services, made by different patient groups, can be compared. Two hundred admissions to an acute accident unit were analyzed and we found that domestic injuries made the greatest demands on nursing and institutional care aspects of the service, by virtue of their frequency and severity. Analysis of road accidents identified the motorcyclist as the largest consumer of resources on an individual basis. Finally, a small but peculiarly demanding group has been identified which consists of patients injured while in hospital.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Skeletal muscle necrosis is quantified using technetium-99m stannous pyrophosphate (99mTc-PYP) in pressurized muscle compartments after severe blood loss. Six dogs (15 to 20 kg) were anesthetized by pentobarbital sodium (25 mg/kg IV) and hemorrhaged to a hypotensive state. Left hind-leg muscle compartments were pressurized to a level of 20 mm Hg for 6 hours by infusing autologous plasma. Intracompartmental pressure was continuously monitored by the wick catheter. The right leg served as a control. Forty-eight hours following pressurization, 5 mCi of99mTc-PYP were injected IV, and 3 hours later each dog was sacrificed and pressurized and control muscles were resected simultaneously, weighed, and counted for99mTc-PYP uptake. Significant uptake appeared in muscle compartments pressurized for 6 hours at 20 mm Hg, indicating that 20 mm Hg in a hypotensive state produces a degree of necrosis as great as that produced by 40 to 50 mm Hg in a normotensive state. We conclude that an acute compartment syndrome occurs in a hypotensive individual at an intramuscular pressure level considerably less than the threshold pressure level in an individual with normal blood pressure.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

There has been little attention paid to the persistence of the pulse following complete forearm arterial transection, and we found no report that has established the etiology or frequency of this phenomenon. Eighteen patients with documented complete radial or ulnar artery transections were evaluated. Nine of the 18 patients had persistently palpable pulses distal to the transections. Seven of the pulses were due to retrograde flow and two were due to transmission from the proximal arterial stump or large collaterals. The Allen test was accurate in demonstrating arterial occlusion in each case. Digital compression of the intact artery eliminated the pulse in those cases due to retrograde flow. Documentation of flow direction and collateral vessels was performed with the Doppler directional velocity meter. The fallibility of the peripheral pulse following complete arterial injury is stressed. The Allen test, digital compression of the intact artery, and Doppler studies should be performed on patients with suspected arterial injuries. The exploration of all wounds in the region of major arteries from which profuse bleeding has occurred is recommended.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

We found that in traumatic shock patients without pancreatic injury, hyperamylasemia occurs in high frequency [49 of 61 (80%)]. Isoenzyme studies of 19 of these patients revealed 18 of them (94%) to have the salivary type of hyperamylasemia. Further, based on the results of the present study, the salivary gland as the organ of origin and the permeability of its cell membranes are suggested as the mechanism for traumatic hyperamylasemia.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The injuries sustained in the first European Knock-down Karate Championships in 1978 are described. Thirty-seven of the 70 competitors sustained an injury. Fifteen of these are potentially serious, head injuries, injuries to the trunk, and hematomata compressing the fascial compartments of the limbs. It is concluded that fights were well controlled by the referees but that protective padding should be used and that wood breaking for further advancement in the competition should be of less importance. Finally, it is concluded that the attendance of a medical officer is mandatory.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Patients with severe thermal injuries often display an impaired cell-mediated immune response. Clinically, this is expressd as an increased susceptibility to infection and, occasionally, as a decreased ability to reject unmatched allograft skin. Experimentally, patient serum is suppressive to the PHA response of normal human lymphocytes, which we have found to be mediated through B cell participation in the generation of suppressor T cells. We herein document the ability of bacterial endotoxin to produce these effects, both in vivo and in vitro.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID