摘要:

Polymorphonuclear neutrophilic leukocytes (PMNLs) play a key role in host defense, and phagocyte dysfunction has been associated with increased susceptibility to infection in patients with thermal injury. We have used flow cytometric analysis (FCM) to longitudinally study PMNL expression of IgG Fc-receptor II (FcγRII) and Fc-receptor III (FcγRIII), as well as the complement receptors CR1 (receptor for C3b) and CR3 (receptor for C3bi) in 22 patients with large burns. Analyses of PMNL complement and immunoglobulin-mediated phagocytosis ofCandida albicanswere performed in parallel. Burn patient PMNL FcγRIII expression was decreased to 58% of control values at admission, and remained low for the first 3 weeks. The expression of patient PMNL FcγRII was not altered at admission or throughout the hospital stay. The CR1-dependent fluorescence was increased by 62% at admission, and reached a maximum at day 2, 138% greater than that of controls. The CR1 expression then gradually returned to normal at discharge. The PMNL CR3-dependent fluorescence showed an increase of 110% at admission and remained high during the first 3 weeks. The immunoglobulin-mediated phagocytosis was decreased by 12% at admission, whereas the lowest value was observed at day 10, with a reduction of 30% compared with controls. The patient PMNL complement-mediated phagocytosis ofC. albicanswas increased by about 160% at admission, and reached a maximum at day 2, before it gradually decreased to control levels at discharge. The expression of complement receptors correlated positively, whereas the expression of FcγRIII correlated negatively, with total body surface area (TBSA) burn. These results demonstrate significant changes of PMNL opsonin receptor expression and opsonophagocytosis, documenting strong systemic activation of PMNLs in the early phase after large burns.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

This study was undertaken to determine the relationship of arterial and venous base deficit (BD) to lactate levels and Svo2in shock and resuscitation with the hypothesis that BD is an equally good indicator of the physiologic changes while being more readily accessible. Fifteen mature swine were bled serially of 25% and 40% of their calculated blood volumes, then resuscitated with lactated Ringer's and blood. Serial hemodynamic and metabolic measurements were made. The BD correlated significantly with lactate levels at all increments of shock and resuscitation. Linear regression analysis demonstrated strong associations (p< 0.001) for arterial and venous BD (R= 0.808), for BD and lactate (R= −0.794), and BD and Svo2(R= 0.538). The BD accurately reflected the hemodynamic and tissue perfusion changes associated with hemorrhagic shock and resuscitation. Base deficit is more readily available than lactate, and is therefore more useful as an index of shock and resuscitation. Venous BD correlates well with arterial BD and can be used when an arterial sample cannot be obtained. The Svo2correlated well with acute volume changes but the addition of supplemental oxygen made it a less reliable indicator of hemorrhage and resuscitation.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

To assess the need for therapeutic laparotomy in patients with blunt abdominal trauma (BAT), ultrasonography (US) and a simple US scoring system were used to estimate the amount of hemoperitoneum during resuscitation. In group I (BAT with a US score > 3), 24 of 25 patients (96%) required therapeutic laparotomy. In group II (BAT with a US score < 3), therapeutic laparotomy was required in only 9 of 24 patients (38%); nonsurgical treatment may be justified in hemodynamically stable patients. Appropriate decisions can be made to perform urgent laparotomy when intra-abdominal bleeding is the culprit in BAT patients. Unnecessary laparotomy can be avoided when the major site of blood loss is not in the abdomen. Ultrasonography, an initial rapid screening procedure in BAT patients, is useful for trauma surgeons in decision making during resuscitation.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The accuracy of ultrasonography (US) in detecting abdominal lesions and free fluid collections in patients with blunt abdominal trauma was evaluated in 250 patients. Particular attention was paid to the role of associated US-guided paracentesis in doubtful cases and in those referred for nonsurgical therapy. The overall sensitivity of US in detecting free fluid collection was 98% (51 of 52 cases) with a specificity of 99% and a positive predictive value of 100%. The overall sensitivity was 93% in spleen injuries, 80% in liver injuries, and 100% in kidney lesions with a positive predictive value of 93%, 100%, and 100%, and a specificity of 99%, 100%, and 100%, respectively. Three stable patients underwent celiotomy on the basis of the results of US-guided paracentesis. The versatility, sensitivity and, repeatability of US, along with its feasibility at bedside and the possibility of performing a guided paracentesis represent the main characteristics that make US the first diagnostic approach to patients with blunt abdominal trauma.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Since 1986, we have cared for 17 patients whose abdomen could not be closed because of bowel edema and loss of abdominal wall compliance. These patients were managed by a technique of visceral packing with the intestines kept in place by a combination of rayon cloth, gauze packs, and retention sutures. This packing was changed in the operating room under general anesthesia until the edema was sufficiently resolved to allow for closure. Two patients died within 24 hours of operation from irreversible shock. The remaining 15 patients had their fascia successfully closed with an average of two additional anesthetics. There was one case of fasciitis associated with the development of an intra-abdominal abscess and one patient died of late sepsis. There was no early postoperative ventilatory compromise or acute oliguric renal failure. Other direct complications have been minor with no enterocutaneous fistulae, dehiscence, or incisional hernia. Visceral packing of posttraumatic abdominal wounds circumvents expected complications of Intraperitoneal hypertension and enhances the chance for survival. Its ease and low morbidity also lends itself to a wide variety of other uses.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The management of traumatic biliary fistulas is controversial. New ideas in nonsurgical treatment have recently evolved, in part because of the rapid advancement of laporoscopic surgery. Three major concepts are important in managing biliary fistulas: diagnosis, drainage, and decompression. These concepts were applied to a trauma patient, then reviewed in detail.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A 4-year retrospective study was made of 111 consecutive surgically treated patients with chronic or subacute subdural hematomas. All underwent single burr hole evacuation with accompanying saline irrigation of the subdural space. Postoperative outcomes at 6 weeks were 90% excellent, 5.5% fair, and 4.5% poor. Postoperative re-evacuation was performed either by needle aspiration or reoperation via the burr hole on 12 patients; one required a craniectomy and neomembrane stripping. These results compare favorably with previous data and support the use of the single burr hole technique as a simple and effective treatment of subacute and chronic subdural hematomas. This addresses the decompression of the brain parenchyma, the removal of the residual semisolid subdural hematoma component, and the removal, dilution, and inactivation of endogenous fibrinolytic agents.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Twenty-two patients were interviewed after lower limb amputation above the ankle joint following fractures. Their median age at the time of the injury was 44 years (range, 14–77 years), and median amputation delay was 2 months (range, 0–213 months). Of the 15 patients who were working before the injury, ten returned to gainful employment after amputation. Amputation delay did not affect the ability to return to work. Twenty patients could walk outdoors; two patients aged 69 and 71 years could not, but regularly went outdoors using a wheelchair or a three-wheeled moped. Eleven patients were more or less dependent on help from others. The study indicates that most patients have an acceptable functional result, but with increasing age the chance of a return to employment decreases, and the need for help with everyday demands increases.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Petrous bone fractures (PBF) in children are relatively frequent. They are mostly diagnosed after collisions and falls. The complications typically associated with PBF were different types of hearing disorders in 69.1% of the patients who had audiometry, liquorrhea in 16.5%, palsy of cranial nerves in 10.8% (facial nerve palsy in 9.4%), bacterial meningitis, stenosis of the external ear canal, and posttraumatic cholesteatoma in 0.7% of the fractures each. Most complications were transient; 8.6% of the patients underwent surgery because of PBF-related complications and 9.4% suffered from severe, irreversible sequelae. Management of PBF in children requires an interdisciplinary approach between pediatric surgeons and pediatric ear, nose, and throat (ENT) specialists. It basically includes daily examination for cranial nerve palsy, liquorrhea, and meningitis during hospitalization as well as routine audiometric examination and antibiotic prophylaxis. Routine vaccination againstStreptococcus pneumoniaeas a new standard procedure and subtotal petrosectomy after transverse fracture as a new surgical modality are strongly recommended in order to lower the incidence of posttraumatic meningitis. Severe complications such as persistent hearing loss, persistent liquorrhea, cranial nerve palsy, and posttraumatic meningitis require aggressive diagnostic and therapeutic measures in order to minimize further morbidity and irreversible deficits.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

In this study, intramedullary reaming and nailing were performed following the insertion of pressure transducers in intact tibias and femora. The femur and tibia were instrumented in 12 sheep (group I) and both tibiae in four (group II). The eight procedures of group II were monitored additionally using echocardiography to detect emboli. Intravasation of fat globules was demonstrated in the blood by the Gurd test and correlated with intramedullary pressure and with echocardiographic monitoring in group II. Medullary nailing was found to be always associated with a severe increase in intramedullary pressure, reaching an average of 1126 mm Hg (304 to 1450 mm Hg) in the tibia and of 753 mm Hg (310 to 1126 mm Hg) in the femur during the first reaming procedures. Particle or fat intravasation was greatest during nail insertion. This phenomenon did not depend on the rise in intramedullary pressure. Our findings indicate that fat and bone marrow intravasation occurs during reaming and nailing in long bones. The maximum embolization of marrow contents demonstrated by echocardiography is seen during nail insertion independent of the changes in intramedullary pressure.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID