摘要:

During the 5-year period ending December 1978, 390 patients were explored for suspected vascular injury either in the neck or in one of the extremities with 13% morbidity and a 1% mortality rate. Positive exploration for vascular injury in 139 patients (36%) resulted in 28% morbidity and 2% mortality. Negative exploration in 251 patients (64%) was associated with a 5% morbidity and 0.4% mortality. Per cent positive exploration by type of injury was: iatrogenic injury (100%), foreign body laceration (100%), blunt trauma (79%), stab wound (32%), and gunshot wound (31%). Per cent positive exploration by area was: brachium (68%), popliteal area (63%), femoral area (28%), axilla (27%), and neck (25%). Routine exploration of patients at risk for vascular injury can be accomplished with minimal morbidity and mortality but is associated with a low (36%) diagnostic yield. ‘Exclusion’ arteriography in hemodynamically stable patients with equivocal signs of vascular injury appears to be indicated to increase diagnostic accuracy.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

From January 1974 through July 1979, 1,588 patients underwent diagnostic peritoneal lavage. The test had an accuracy of 98.6%, sensitivity of 94.3%, and specificity of 99.8%. It was true positive in 21.9%, false positive in 0.1%, false negative in 1.3%, and true negative in 76.6%. Fifty-nine patients from the true-positive group had grossly equivocal tests, but had positive lavage results based on quantitative cell count. Thus without cell count the test would have a sensitivity of 78.3%, accuracy of 94.8%, and specificity of 99.8%. Eight patients had positive lavage based on WBC count but negative RBC count; all of these patients had bowel injuries. Measurement of lavage fluid amylase resulted in minimal or no improvement in the accuracy (0.06%), sensitivity (0.3%), or specificity (0.0%). Five of six patients with positive amylase levels but grossly negative tests had concomitant positive WBC count. The added cost of the amylase measurement is estimated to be $154,472. Peritoneal lavage has high accuracy, sensitivity, and specificity. Cell counts significantly improve sensitivity. Patients with a grossly equivocal test but with a positive cell count should undergo laparotomy. The lavage-fluid amylase measurement is costly and is of insignificant yield.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Four types of progressive necrotizing surgical infections have been described, based on the type of infecting organism, the type and depth of soft tissue penetration and clinical findings, and the type of surgical therapy recommended, e.g., necrotizing fasciitis, clostridial cellulitis. A mortality rate of up to 50% continues to be reported. An experience with 20 such cases indicates that there is a considerable overlap in clinical-physical findings and bacteriology such that classification schemes are confusing and lead to treatment delays and the use of inappropriate therapy. The infections all seem to be variations of the same disease process, a spreading, necrotizing infection. Of the 20 cases, four were treated with antibiotics and delayed (1 to 3 days) excision of necrotic tissue with 75% deaths; four cases received antibiotics and multiple surgical incisions with 100% deaths. The other 12 cases were treated with a unified approach of resuscitation, antibiotics (penicillin, clindamycin, tobramycin), immediate surgical excision (3 to 4 hours) of all necrotic tissue, aggressive nutritional support, and early skin coverage, with an 8.3% mortality. We conclude that there seems to be no need to classify necrotizing infections into different types. Recognizing them as the same disease process and treating them with a unified approach resulted in a significant reduction in mortality.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The pathogenicity of several strains ofPseudomonas aeruginosafor burned rats (3° scald burns, 20% body surface) following topical application of the bacteria to the burn within 1 hour after burning was established. Following this, it was demonstrated that purposeful infection of such 3° scald burns of rats by a strain ofPs. aeruginosaof low virulence (JB-77) protects the rats from the lethal effect of subsequent (48-hour) topical contamination of the burn by a highly virulent strain ofPs. aeruginosa(VA-134) (p< 0.001). This finding was confirmed in a similar experiment beginning with germfree rats. When the challenge with the highly virulentPs. aeruginosastrain was 24 hours (rather than 48 hours) after the burning and topical contamination of the burn with the low virulence strain ofPs. aeruginosa, there was little protection (pN.S.). When burned rats were given the low virulence strain ofPs. aeruginosaby gavage right after burning, there was no protection to subsequent (48 hours) challenge by topical application of the highly virulent strain ofPs. aeruginosato the burn (11/12 vs. 12/12 dying).Our finding that purposeful infection of a 3° burn of rats (conventional and also germfree) by a strain ofPs. aeruginosaof low virulence protects from the lethal effect of subsequent (48-hour) topical contamination of the burn by a highly virulent strain ofPs. aeruginosais due, we believe, to direct bacterial interference between the two strains of pseudomonas.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Benzopyrones are a class of drugs which have been used clinically and experimentally in Europe and Australia to reduce tissue swelling caused by high-protein edema states. These drugs are not available nor have they been investigated in the United States. This pilot experiment was designed to determine if one of these compounds, 5,6 benzo-alphapyrone, is effective in reducing traumatic edema from thermal and crush injury.Method: One hind limb of 34 Sprague-Dawley rats was immersed for 30 seconds in 55° C water and the animals divided into three groups as follows: Group I—no treatment; Group II—17cc saline/kg body weight IP; Group III—25 mg 5,6 benzopyrone in 17cc saline/kg body weight IP. In another 30 S-D rats, the soft tissue of the posterior aspect on one hind limb was crushed in a Servistor®vise (jaws to within 1 mm of each other) for 5 minutes. They were divided into three groups and treated as in the thermal injury group. After 24 hours both limbs were amputated, weighed, dried, and reweighed.Crushed and burned rat hind limbs treated with benzopyrone after injury had significantly greater dry weights (less edema) than did untreated or saline treated limbs. Benzopyrone appears to be effective in reducing edema following crush and thermal injury in this experimental system. Further studies are being conducted to elucidate the mechanism of action of benzopyrones, their potential activity in other postinjury edema, and their effect on tissue survival.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Ninety-five patients with fractures of the tibial plateau have been reviewed. The fractures were grouped, according to the X-ray pattern, into five fracture types. Treatment was grouped into plaster immobilization or traction in the conservative group, and open reduction with internal fixation, open reduction with bone grafting, or open reduction with internal fixation and bone grafting in the operated group.It was concluded from this review that tibial plateau depression or tibial plateau widening of less than 10 mm was usually tolerated well and did not preclude a successful result. Adequacy of reduction was at least as important as early motion in obtaining a satisfactory result regardless of the type of fracture treated. If open reduction is undertaken both internal fixation and bone grafting are required in the most common types of these fractures. The exceptions are Type I or split fractures which do not require a bone graft and Type III or central depression fractures which do not require internal fixation.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Twenty-nine patients had splenic or hepatic defects on99mTc sulfur colloid scintigraphy performed after abdominal trauma. All were treated conservatively. One additional patient had a scan after a laceration was oversewn. Followup scans in 24 patients 1 to 13 months later showed resolution that was complete in nine, partial in 12, and unchanged in three. No defects enlarged. All but two patients were completely asymptomatic; two children with occasional unexplained upper abdominal pain had progressively resolving splenic defects. We conclude that surgery may not always be necessary for liver-spleen injury, that radionuclide imaging is useful in evaluation of healing as well as in initial diagnosis, and that the risk of ‘delayed’ rupture is much smaller than heretofore feared.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

We report on our laboratory and clinical experience with a new hemostatic agent made of collagen fibers and existing in the form of a loose or compressed fleece. This material was tested in two independent bleeding models on eight dogs and 21 patients.Partially compressed collagen fleece showed significantly higher hemostatic effectiveness when compared to loose fleece. This was demonstrated by gravimetric determinations of blood loss in dogs with split-thickness skin excisions and by measuring the blood loss and time of bleeding after an excision 0.5 cm deep and 4 cm wide of the edge of the spleen. The handling of partially compressed hemostatic fleece was found superior to loose or fully compressed fleece. Clinical cases included patients with liver lacerations and retroperitoneal bleeding. Collagen fleece, partially compressed, proved to be an effective topical hemostatic agent when applied directly with pressure to a bleeding surface and when folded and sutured against a bleeding surface. Postoperative infection rate was not increased nor was foreign body reaction demonstrated. The material was extremely easy to apply, did not adhere to gloves or instruments, and could be cut or molded to any desired shape.

ISSN:0022-5282    

出版商:OVID    

年代:1981

数据来源: OVID