摘要:

We determined the generation and metabolism of lipoxygenase products in isolated granulocyte fractions of patients with multiple trauma (n = 9) and compared the results with those of healthy volunteers (n = 8). The supernatants of stimulated cells were analyzed by high-performance liquid chromatography. During the first week after injury a significantly reduced capacity to generate LTB4and an increased metabolism of LTB4into β-oxidated products (20-OH-LTB4and 20-COOH-LTB4) were observed after stimulation of the granulocytes with Ca ionophore. The depressed leukotriene production could be partly abrogated by the addition of arachidonic acid. These findings are comparable with alterations previously described in severely burned patients with postburn sepsis. Additionally, an elevated production of LTC4by peripheral granulocyte fractions was observed in two patients suffering from adult respiratory distress syndrome (ARDS) as well as an increased number of eosinophils during the time of lung dysfunction. Analysis of bronchoalveolar lavage in patients with multiple trauma (11 patients with ARDS and 11 patients without ARDS) by a specific radio-immunoassay confirmed an elevated production of cysteinylleukotrienes. The presence of LTC4was detected in 61 of 124 lavages (49%), levels ranging between 0.2–5.9 ng/mL lavage fluid in the ARDS group, in contrast with 10 of 108 lavages in the control group; in all ARDS patients eosinophils (>2% of all nuclear cells) could be detected in more than one lavage (total: 51 of 116 lavages), in contrast with the non-ARDS group (14 of 101); the linear correlation in the ARDS group between the individual levels of LTC4and eosinophils was atr= 0.52 (non-ARDS groupr< 0.20).

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Total proteolytic activity (PA) is increased in the circulation of pediatric burn patients. The extent of the increase correlates with the percent total body surface area (TBSA) burned and is associated with increased susceptibility to fatal infection. To determine the source or sources of this PA, three factors were evaluated: (1) levels of proteinase inhibitors—antithrombin, α2-antiplasmin, and α1-proteinase inhibitor; (2) levels of proteinase—neutrophil elastase; and (3) activation of circulating proteolytic cascade systems as indicated by changes in levels of system components—plasminogen and prekallikrein. All assays measured functional levels of the proteins. Normal levels were determined in 25 consecutive well children who were seeing their pediatrician for checkups (14 boys, 11 girls, ranging in age from 10 months to 17 years). Twenty-five consecutive burn victims admitted to the Shriners Burns Institute, Cincinnati Unit (19 boys, six girls, aged 10 months to 17 years), with a mean full-thickness burn of 43.2% TBSA (range, 6%-87%) were studied in the first week postburn. Antithrombin, α2-antiplasmin, plasminogen, and prekallikrein levels decreased (p< 0.001) postburn, whereas elastase increased (p< 0.001). We conclude that, in pediatric burn patients, decreased proteinase inhibitors, increased proteinase, and activation of circulating proteinase cascades all contribute to elevated total circulating PA postburn.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Sixty-four patients with soft-tissue injuries were studied prospectively to determine whether an initial venous bicarbonate concentration (VBC) of less than 17 mmol/L would predict the development of myoglobin-induced acute renal failure. The VBC was > 17 mmol/L in 59 patients, seven of whom had myoglobinuria. All recovered without renal complications. The remaining five patients all had VBC < 17 mmol/L and four had myoglobinuria. Acute renal failure developed in four patients (p< 0.001). The VBC on hospital arrival was the most accurate predictor of these patients' risk for the development of acute renal failure following soft-tissue injury.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

It has been estimated that 26% of Americans are obese. A very small subset of this group can be categorized as morbidly obese, fulfilling the criteria of being 100 pounds, or 100%, over ideal body weight. The clinical records of seven morbidly obese burn patients treated over a 20-year period are reviewed. Particularly notable was a 43% incidence of fatal pulmonary embolism.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Phosphorus-31 nuclear magnetic resonance techniques using shallow penetrating coils have been used to noninvasively monitor severity and metabolic changes over time in skin wounds in rats. Ratios of phosphocreatine (PCr) to inorganic phosphate (Pi) indicate energy status in both thermal wounds and surgical flaps. In partial and full-thickness scald wounds, reductions in PCr/Pi ratios correlated with burn depth and improved over time postinjury, suggesting wound revascularization. No decrease in intracellular pH was noted in these wounds; the phosphate shifts may be primarily the result of tissue degradation followed by restoration of the microvasculature. Distal regions of caudally based dorsal 3 x 10 cm full-thickness skin flaps reveal progressively lower PCr/Pi ratios to 3–6 hours after elevation as well as drops in pH up to 0.5 units, presumably as a result of anaerobic glycolysis in these tissues. After 24 hours, the intracellular pH returned to normal (7.1–7.2) and the PCr/Pi ratios approached 70%-90% of the well-perfused proximal regions within 3–7 days. These results indicate the establishment of a microvasculature from the underlying bed as the distal regions survive as free grafts. The data demonstrate the potential usefulness of the technique in noninvasive measurement of the biochemical response to injury and wound healing in living organisms.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

To assess the relationships between core temperature (T) and other factors relating to operating room (OR) blood loss and mortality following abdominal injury, the records of 122 patients undergoing laparotomy for trauma at Detroit Receiving Hospital over a 1-year period (1989) were reviewed. Most injuries were penetrating (86%) and the mortality rate was 8.2%. Overall, 57 of 122 (47%) had hypothermia (T < 35°C) upon arrival in the OR. There was a significant correlation between admission blood pressure and lowest intraoperative temperature (r= 0.60;p< 0.001). Multiple regression analysis revealed that the patient's lowest temperature (p< 0.001) and Trauma Score (TS);p< 0.0015), but not Abdominal Injury Severity Score (AISS) (p= 0.25) correlated with OR blood loss. The 28 patients with high TS (15 or 16) and AISS > 9 had significantly less blood loss when the OR temperature was maintained above 35°C versus 33°-35°C (540 ± 580 mL vs. 1820 ± 1160 mL;p< 0.003). This suggests that hypothermia may exacerbate OR blood loss independent of degree of physiologic or anatomic injury. Thus hypothermia is common in patients undergoing a laparotomy for trauma. Trauma scores and the presence of shock preoperatively correlate with the development of intraoperative hypothermia. Hypothermic patients with similar injury severity have greater blood loss. Prevention and rapid correction of hypothermia during resuscitation and surgery appear to be extremely important in reducing blood loss in this patient population.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Large skeletal defects of the femur caused by infected nonunions remain a challenge to orthopedic surgeons. Conventional bone grafting may not succeed when the recipient bed is not ideal. Single fibular grafts were proven very useful in bridging this type of defect, yet were complicated by the high incidence of refracture and the need for protection of long duration. By dividing the fibula into two stouts connected by the nutrient vessels, we doubled the effective cross-sectional area of bone grafting with only one set of vascular anastomoses. Five cases of infected nonunion of the femur after a high-energy trauma were successfully managed with this technique. All the fractures healed in an average of 7 months. By 1 year the grafts hypertrophied to the size of the femur. A follow-up of at least 2 years recommends this technique in the management of certain chronic osseous defects of the femur.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

This study retrospectively reviewed 142 fatal cases of aortic laceration. Data were collected from the autopsy reports (including toxicology results) and included the circumstances of the the injury. In the case of automobile crashes this included the direction of impact, time of day, and vehicular damage. Seventy percent of the victims were men with a mean age of 37.5 years; 30% were women with a mean age of 46 years. Thirty-five percent of the 142 victims had elevated blood alcohol levels. Fifty-four percent of the lacerations were located at the classic site (the isthmus). The majority of the aortic lacerations (102) were sustained in automobile crashes. Of these, 42% were broadside collisions and 58% were head-on collisions. Seventy-three percent and 67% of the victims in broadside and head-on collisions, respectively, had aortic lacerations at the classic site. The results suggest that the pathogenesis of aortic rupture involves a lateral oblique compression impact to the chest, which causes thoracic mediastinal structures to shift and deflect the aortic arch, resulting in severe shearing and stretching at the isthmus. The use of seat belts and air bags may reduce the number of aortic injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

This study identified a number of significant predictors of per capita county trauma mortality rates: rurality, percentage nonwhite population, percentage unemployment, and Advanced Life Support (ALS) versus Basic Life Support (BLS) status. Of these, ALS versus BLS status is not only the most significant independent predictor, it is the only predictor readily amenable to change. The aspects of ALS clearly associated with decreased trauma death rates should be identified and, if possible, undergo widespread implementation.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID