摘要:

Survivors of innominate and other major cardiovascular injuries are being seen with increasing frequency. Penetrating injuries more frequently involve the distal innominate artery and innominate veins. Associated subclavian and carotid artery injuries are more frequent following penetrating trauma. Blunt trauma typically involves the proximal innominate artery. A variety of operative exposures is useful but the selection of incision frequently depends upon the presence or absence of associated mediastinal injuries. Partial or complete median sternotomy in combination with various cervical and thoracic extensions is advised. Successful management of innominate artery injury can be performed without the aid of cardiopulmonary bypass or arterial shunts.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The urinary excretion of sulfur-containing compounds was studied in 11 burned patients during the first 10 days after injury. They were all given carbohydrate and fat by parenteral nutrition. Two patients also received large amounts of amino acids including methionine, whereas five patients were given amino acids including moderate amounts of methionine and cysteine. A sustained high excretion of mercaptolactate occurred in most patients. The excretion was not influenced by the type of parenteral nutrition, but related to the area of burned skin. A normal excretion of methionine, cyst(e)ine, inorganic sulfate, taurine, mercaptoacetate, thiosulfate, and thiocyanate was found at the end of the observation period in patients without amino acid therapy. Increased amounts of inorganic sulfate and methionine were excreted in patients receiving high doses of methionine, whereas an increased cyst(e)ine and taurine excretion was the most prominent finding in patients receiving moderate amounts of methionine and cysteine. These results indicate that burned patients have an unimpaired ability to metabolize sulfur amino acids. Patients not receiving amino acids or receiving moderate amounts of cysteine and methionine showed a negative sulfur balance, whereas patients given high doses of methionine maintained sulfur balance at near-zero levels. However, since signs of hepatic dysfunction appeared in the latter group, parenteral nutrition with amino acid mixtures containing high amounts of methionine is not recommended during the catabolic phase for burned patients.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The indications for aortography in patients sustaining blunt chest trauma have increased as the number of radiographic and clinical findings associated with traumatic rupture of the thoracic aorta (TRA) proliferate. No studies, however, have demonstrated whether these findings are useful in selecting patients for aortography. In order to determine the predictive value of reported associations in TRA, the presence or absence of nine radiographic and nine clinical findings associated with TRA were tabulated and tested for correlation with the results of aortography in 173 consecutive patients who underwent arch aortography from 1975 to 1980 to rule out TRA following blunt trauma.Mediastinal widening was the most reliable indicator of TRA. All patients less than 65 years old with TRA presented with mediastinal widening. In patients under 65, the reliability of mediastinal widening to predict TRA was not enhanced by any other clinical or radiographic finding studied. On the other hand, only two of six TRA's in patients over 65 had mediastinal widening. Only in this group over 65 did other publicized indications for aortography, including pulmonary contusions or multiple rib fractures including ribs 1 and 2, have any association singly or in combination with TRA.We conclude that all trauma victims who have a widened mediastinum should undergo aortography. Other reported associations by themselves are not absolute indications for aortography except in patients 65 years old or older.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Advances in prehospital emergency care have increased the numbers of patients arriving at the hospital with immediate life-threatening trauma. This is a review of our recent 6-year experience with 161 major abdominal vascular injuries in 123 patients. The distribution by injury site and respective mortality were: 18, aortic (56%); 39, aortic branch (37%); 51, inferior vena cava (39%); 30, inferior vena cava branch (45%); and 23, portal venous system (39%). The overall death rate was 37%. Forty-six patients presented with unobtainable blood pressure and 19 (41%) survived. Left thoracotomy and temporary aortic occlusion were required in the resuscitation of 45 patients; when applied in the emergency department the salvage rate was 7%, and in the operating room, 35%. Forty-four patients had more than one major vascular injury and 17 (39%) recovered, compared to a survival rate of 76% with single vascular trauma. Others have emphasized that most deaths from major abdominal vascular injury are a result of hemorrhage. In our study although 89% of mortality was due to bleeding, half occurred after control of the major bleeding sites. These findings suggest that coagulopathy, hypothermia, and acidosis are complicating factors which demand as much attention by the surgeon as the initial resuscitation and operative control classically emphasized.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Acute subdural hematoma (ASDH) due to ruptured bridging veins occurs under acceleration conditions associated with high rates of acceleration onset. That this is due to the strain-rate sensitivity of these veins was confirmed in an experimental model of ASDH. The results of this model were consistent with the clinical causes of ASDH, where 72% are due to high-strain falls and assaults and 24% are due to lower strain-rate vehicular injuries. A mathematical model embodying the known mechanical properties of subdural veins was used to develop tolerance criteria for the occurrence of ASDH. This tolerance curve was consistent with the clinical and experimental data but differed from tolerances previously proposed for head injury.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

A randomized prospective double-blind trial was conducted to determine the effectiveness of cephalothin vs. placebo given perioperatively for prevention of infections associated with operations using skin grafts for clean reconstructive surgery following burn injury. The antibiotic was effective in reducing infection (0.8% vs. 5.7%,p< 0.03), reducing graft loss (p< 0.02), and shortening hospital stay (12.38 days vs. 13.66 days,p= 0.02). Factors not associated with greater graft infection included the operating surgeon, the use or nonuse of a tie-on stent, graft thickness, large size of graft, and patient age.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Review of 100 consecutive patients with pelvic fractures admitted to a trauma service during an 11-month period was undertaken in order to define the factors which affected the mortality. Mortality was most significantly affected by severity of injury, presence of a head injury, admitting blood pressure, admitting hemoglobin level, and requirements for blood and blood products. Evaluation of anatomic configuration of fractures demonstrated that posterior fractures required larger amounts of blood and blood products, had a significantly decreased admitting blood pressure, and had a significantly higher mortality, despite there being no significant difference in injury severity between patients having anterior or posterior fractures.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The rural area is not immune to multi-casualty incidents, and the complete rural EMS System reported here includes a plan to deal with one. The Susquehanna Valley Health Care Consortium was developed with this in mind, and addresses the points pertinent to the rural setting, including the large area served, available medical care, prehospital transport, and communications. Six hospitals in five counties participate. New approaches to these problems, which emerged after three field tests, are: participants must be organized for successful triage and resuscitation; crowd and traffic control by police is mandatory; an overall commander is necessary; two-way communication by several methods must be available; an administrator should track all victims; and air evacuation capability should be arranged.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Scalp avulsions of various origin are frequently seen, owing to rapid industrialization and the increased incidence of road-traffic accidents. This article deals with 20 such cases seen and treated by the authors in the last 5 years. The victims were predominantly young females. The anatomic and pathophysiologic aspects of avulsion injury are considered in detail, and various modalities of treatment are discussed. With intact pericranium, split-skin grafting remains the treatment of choice. In the presence of bare bone, local flap is preferred, if feasible. If not, then the outer table of the skull is chiseled out or multiple drilling is done through it to accelerate the formation of granulation tissue. Subsequently, this is covered by split-skin grafting. Of course, the grafts do not grow hair and the patients need to wear a wig for total psychological and functional rehabilitation. Prevention remains still the best remedy.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Therapeutic results from extremity vascular injuries have been improved by early definitive care by surgeons trained in peripheral vascular techniques. Serious venous injuries are uncommonly seen other than in large urban referral centers or military installations. Seventeen patients with major femoral venous injuries were evaluated over the past 25 years at the North Carolina Memorial Hospital. The records from these patients were analyzed regarding mechanisms of injury, time delay for definitive care, clinical presentation, significant associated injuries, operative management of the venous injury, early and long-term morbidity, and mortality. Major femoral venous injury was associated with simultaneous arterial injury in 59% of cases. Primary venous repair was performed in seven cases with a satisfactory functional result in all instances. Chronic venous insufficiency developed in five patients (29%), all of whom had arterial injuries and venous ligation. Postoperative complications were commonly related to associated injuries. No patient in this series developed thrombophlebitis or a pulmonary embolus. Isolated femoral vein injuries are usually associated with both early and late favorable results. Femoral vein ligation in the presence of arterial injuries usually leads to serious long-term venous disability. When technically feasible, operative repair of major femoral vein injuries is advocated.

ISSN:0022-5282    

出版商:OVID    

年代:1982

数据来源: OVID