摘要:

Because the serious nature of penetrating cervical injuries may not be readily apparent on initial evaluation, and since delay in treatment can result in serious complications, a systematic method of evaluation and routine exploration has been employed in treating these injuries. One hundred eightynine patients, 49 with gunshot wounds and 140 with stab wounds, were treated in this series. Arteriography was performed in 62 patients (33%) to detect vascular injuries and to aid in the planning of the operative approach in patients with high or low neck wounds. Arteriography was 98% accurate and changed the operative approach in 29% of the positive studies. Of the 154 explorations 72 were positive (47%). There were no deaths and only four complications in the group with negative explorations. The mortality rate for the series was 2.6%. We believe that angiography in selected patients and routine exploration of wounds penetrating the platysma can minimize morbidity and mortality in these injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

We have developed a photoplethysmographic technique for monitoring early signs of vascular compromise in extremities affected by direct vessel trauma, crushing trauma, or circumferential burns. The technique consists of positioning a small infrared emitter-detector array shielded from room light over a nailbed of the affected extremity and connecting the array to standard electronic monitoring equipment, thus producing a pulse tracing very similar in contour to an arterial pressure wave. In normal volunteers, simultaneous observations of the tracing and studies of muscle blood flow using Xe133clearance showed correspondence of disappearance of the plethysmographic signal with limb-threatening levels of ischemia produced by inflation of a blood-pressure cuff. Studies comparing this technique to compartment pressures and arterial flow determined by ultrasound Doppler measurement are continuing. Clinically, we have used this monitoring technique on 29 trauma patients thus far, including 18 with circumferential full-thickness burns of at least one extremity. We believe that these preliminary studies suggest that photoplethysmography is a valuable continuous monitor of vascular status following trauma and a reliable indicator of nutritional blood flow.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

With the increased nationwide incidence of major vascular injuries, the need for interposition grafting has become quite common in major trauma centers. Despite extensive experience with such injuries, the choice of a substitute conduit remains controversial. Recent studies have demonstrated the potential of expanded polytetrafluoroethylene (PTFE) as a replacement graft for small arteries and veins. The surgical services at the Ben Taub General Hospital began to use PTFE grafts in traumatic vascular wounds approximately 2 years ago. Eight axillary arteries and 12 brachial arteries have had interposition grafting with PTFE prostheses. Eleven patients have required PTFE interposition grafts in repair of traumatized common, superficial, and profunda femoris arteries and common femoral veins; eight patients had reconstruction in the popliteal artery or vein. Three patients had renal artery revascularization procedures following blunt abdominal trauma, three patients had segmental replacement of the superior mesenteric artery following gunshot wounds, and one carotid artery, one iliac vein, and two axillary veins were grafted with PTFE. All patients with segmental repair of axillary, brachial, femoral, and popliteal vessels have maintained good distal pulses and viable extremities. No grafts have thrombosed, nor become infected, in spite of soft-tissue injury encountered at time of repair. In situations requiring interposition graft placement for reestablishment of distal flow in small arteries and veins, PTFE grafts appear to be an acceptable prosthesis.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

High-voltage electric burns are often associated with deep muscle damage in addition to a limited cutaneous burn. Technetium-99mstannous pyrophosphate (99mTc-PYP) scintigrams were evaluated as a diagnostic tool to detect and localize both large and focal areas of skeletal muscle necrosis. Scintigrams were performed in 14 patients between the first and fifth postinjury days and imaging was done over areas of suspected and clinically apparent muscle injury. Muscle damage was identified by an increased cellular uptake of the tagged material. All 14 patients had gross and histologic evidence of muscle necrosis. Muscle necrosis was identified as early as 24 hours and as late as 6 days postinjury. The location and extent of muscle injury was correctly ascertained preoperatively in all patients.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Decortication of post-traumatic empyema (PTE) was performed in 27 patients from 1972 through 1977. All 27 patients had penetrating chest wounds and were refractory to antibiotics and tube thoracostomy. Factors associated with PTE included unrecognized diaphragmatic perforation, large hemothorax greater than 500 ml, pulmonary contusion, extrathoracic extension of hematoma within the chest wall, and incomplete expansion of the lung with initial tube thoracostomy. Prophylactic antibiotic usage did not prevent PTE nor lead to negative intrapleural cultures preoperatively. The timing of decortication varied with indication: two patients with infected pneumothorax had surgery within 1 week; 15 patients with infected pleural clot had surgery within 4 weeks; ten including nine who were readmitted to the hospital had surgery more than 4 weeks after injury. Prevention of PTE requires early recognition of hemo- or pneumothorax, early tube thoracostomy with complete evacuation of blood and expansion of lung, careful daily monitoring of subsequent fluid accumulation, and prompt evacuation when such fluid accumulates. Once PTE becomes well established and refractory to standard modalities, decortication with evacuation of the empyema cavity should be performed as soon as possible.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Forty-one unanesthetized cynomolgous monkeys were subjected to 2 hours of hemorrhagic hypotension at various mean arterial pressures (MAP) between 40 and 60 mm Hg. Resuscitation and maintenance of MAP were provided by lactated Ringer's solution and homologous blood. Thirty-eight per cent (57% of those surviving >24 hours) developed a delayed-onset (18 to 24 hours) pulmonary insufficiency in spite of good urinary output, and which did not respond to furosemide. The group in which this caused death (24%) showed significantlydecreasedPaO2, PaCO2, dynamic compliance, and FeCO2, andincreasedminute volume, Qs/Qt, pulmonary artery pressure, and Vd/Vtbefore death. Their lungs were heavier, with abnormal pressure/volume curves and increased minimum surface tension. During the entire post-resuscitation phase, this group remained in a high-output, low-resistance hemodynamic state in contrast to survivors and those dying of shock. The implications regarding current practices of monitoring and resuscitating patients with traumatic shock are discussed.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Cardiovascular and respiratory parameters were obtained in 374 studies from 151 patients (64 septic or septic shock and 87 with nonseptic cardiogenic syndromes). Cardiac output and related measures, respiratory parameters, pulmonary blood volume (DV/m2), cardiac ejection fraction (EFx), left ventricular end-diastolic volume (LVEDV), peripheral resistance (TPR), pulmonary shunt (Qs/Qt), physiologic dead space (Vd/Vt) and mean ventilation perfusion ratios (Va/Qt) were calculated. Both physiologic evaluation and multivariable statistical analyses of the data were performed. For a given level of (A-aO2gradient/PaO2) septic patients have a higher Qs/Qtthan cardiogenic patients. Hyperdynamic septic patients have a larger Qs/Qt, a greater Vd/Vt, and a lower VA/Qtand TPR than cardiogenics. The decrease in Va/Qtand the rise in VD/VTare strong functions of the increasedEFx, which raises cardiac index (CI) and reduces LVEDV and the mean dispersion of pulmonary blood volume, thus causing hemodynamic redistribution of flow. Qs/Qtis mainly a direct function of the increase in CI which also tends to reverse theEFxmediated rise in VD/VT. The role of the septic mediated decrease in TPR as a contributing pathologic feature and the use of volume infusion to raise LVEDV and Va/Qtin high-CI septics with large Qs/Qtis discussed.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Cardiac tamponade was diagnosed in 197 patients admitted over 20 years (1955–1974) to the Charity Hospital of New Orleans, for emergency treatment of penetrating mediastinal injuries. Of the 197, 174 definitively treated patients followed one of three patterns of management: 96 had OR thoracotomy, 68% were unstable, and preoperative pericardiocentesis reduced mortality from 25 to 11% (p< 0.01); 44 had emergency thoracotomy, 91% were unstable, and prethoracotomy pericardiocentesis decreased mortality from 94 to 63% (p>

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

During the 10-year period ending 1 March 1978, 100 consecutive patients with penetrating cardiac wounds entered the Bexar County Hospital with some sign of life. The early and late mortality rate. 11%, declined to 8% during the last 4 years. Noncardiac injuries were responsible for six of the eleven deaths. Complications occurred in 17. The most frequently injured chambers were the right ventricle (46) and left ventricle (30). Sixty-nine patients had stab wounds and 26 had gunshot wounds. Pericardiocentesis was falsely positive or negative in 12 of 47 patients. Two distinct syndromes were apparent, hemorrhagic shock and cardiac tamponade. Patients with shock had immediate thoracotomy. Patients with suspected tamponade had a subxiphoid pericardial window, under local or light general anesthesia, for diagnosis and decompression before endotracheal intubation and sternotomy. Most wounds were repaired by direct suture. Cardiopulmonary bypass and thoracotomy before arrival in the operating room were rarely indicated.

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1979

数据来源: OVID