摘要:

Plasma fibronectin is a large molecular weight glycoprotein which may have both opsonic and structural adhesive roles. Fibronectin deficiency has been documented in patients especially early after trauma or burn as well as during sepsis following injury. In this study, the disappearance of fibronectin from the blood was studied in rats utilizing plasma fibronectin metabolically labelled with75Se-selenomethionine. After injection of75Se-selenomethionine, the maximum specific activity of endogenously labelled plasma fibronectin was observed at 4 hours. Thereafter, it declined in a non-monoexponential fashion in association with depletion of the precursor. Labelled75Se fibronectin was purified from donor rat plasma by gelatin-sepharose affinity chromatography. It retained its electrophoretic mobility, gelatin adherence, and opsonic activity similar to that of unlabelled plasma fibronectin. Following intravenous injection of75Se plasma fibronectin, its disappearance from plasma manifested two phases. The first was an initial fast disappearance of a small amount of fibronectin, reflecting distribution between plasma and interstitial compartments. The second was a slower disappearance phase with a half-time (T1/2) of at least 15 hours. Infusion of gelatin-coated particles, which are rapidly cleared by RE cells in the liver and spleen, enhanced the disappearance of75Se fibronectin from the plasma. These data suggest that the normal rate of fibronectin disappearance from the vascular space is quite fast. Utilization of this experimental approach may provide valuable data on fibronectin kinetics as influenced by trauma and burn.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The relationship between plasma catecholamines and injury severity was investigated in order to determine: a) whether a correlation existed between the severity of injury as assessed by the Injury Severity Score (ISS), and circulating noradrenaline and adrenaline; and b) whether such measurements were of prognostic value. It was found that in the immediate postinjury period, both noradrenaline and adrenaline correlated positively with ISS over the range of injury studied (ISS = 0–54;r= 0.67,p< 0.01). It appeared that part of the response might be attributed to psychological rather than physical factors; at lower levels of injury (ISS < 9) these psychological factors were possibly responsible for the whole of the observed effect. In the subsequent recovery period (> 24 hr postinjury) no clear relationship between plasma catecholamines and injury severity was maintained. Studies on patients who died as a consequence of their injuries failed to confirm the previously suggested prognostic value of plasma catecholamine determinations in this later postinjury period. However, plasma noradrenaline levels in this group were significantly higher on admission than in the casualties who survived serious injury (p≤ 0.05). It is concluded that plasma catecholamine concentrations, in combination with other indices of injury severity, may provide useful information on the response to injury in man, and aid in the assessment of its overall severity in physiologic terms.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Stimuli involved in induction of alterations of the complement system and production of circulating inhibitor(s) of phagocytic function of polymorphonuclear neutrophils following burn injury were investigated using a guinea pig model of scald burn injury. The activity of C1-C9, assessed by measurement of total hemolytic complement, was found to increase primarily in response to burn injury per se, whereas reduction in the activity of the alternative complement pathway was shown to develop in association with natural colonization and local burn wound infection with bacterial pathogens. Invasive burn wound infection induced experimentally withStaphylococcus aureus, Pseudomonas aeruginosa, orCandida albicansexacerbated this latter abnormality, caused consumption of C1-C9 activity, and was associated with appearance of serum factors that depressed phagocytosis ofEscherichia coli075 by peritoneal polymorphonuclear neutrophils. Thus injury and coexistent infection both play important roles in induction of humoral alterations of host defense associated with burn injury.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Alterations in circulating thyroid hormone concentrations occur in a variety of nonthyroidal disease states. In the present study, thyroid hormone levels were measured every 8 to 12 hours in 19 otherwise healthy individuals suffering acute severe trauma necessitating admission to the Maryland Institute for Emergency Medical Services Systems. Four fatalities occurred within 48 hours of admission. The mean total T3 level fell rapidly after the onset of trauma and remained low throughout the observation period. Reverse T3 rose concurrent with the fall in T3 but gradually returned to normal in the survivors. Total and free T4 levels remained normal in the survivors but fell below normal in the fatalities on the samples obtained preceding death. Changes in free T4 were consistent in three separate radioimmunoassay systems.Pharmacologic doses of glucocorticoids administered to seven of the 15 survivors and to the four fatalities did not result in an acute depression in total and free T4 levels in the survivors. Post-mortem examination of three fatalities did not reveal evidence of significant thyroid or pituitary disease. These results suggest that in acutely traumatized patients: 1) T3 declines rapidly and remains depressed throughout the illness; 2) continued fall of T4 to subnormal levels is associated with a poor prognosis; and 3) steroid therapy alone cannot explain the acute changes observed in hormone levels.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Over a 15-month period, 74 trauma patients who were expected to require extended intubation were studied prospectively to evaluate the appropriateness of tracheostomy. Patients were randomized to receive either early (34) or late (40) tracheostomies. The patients also were grouped to determine the difference of early versus late tracheostomy on the development of laryngotracheal pathology and respiratory infections; length of intubation and type of patient injury were studied as possible differential factors. Fifteen per cent (11/74) of the patients developed major laryngotracheal pathology as identified by endoscopy, and respiratory infections developed in 54% (40/74), but there was no significant difference in the complication incidence between the early and late tracheostomy groups. Significantly more complications occurred in rigid-posture, head-injured patients than in any other trauma grouping, but there was no significant difference in the complication incidence between the two tracheostomy groups within that classification. We conclude that patients can undergo translaryngeal intubation for up to 2 weeks without significantly increasing complications relative to transtracheal intubation.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Reported mortality from pancreatic trauma remains at approximately 20% and morbidity is about 33%. A recent series was reviewed to highlight unresolved problems associated with this injury. From 54 consecutive patients treated operatively for pancreatic trauma during a recent 7-year period, 44 patients were evaluated. Among these 44, six died and 12 developed fistulas and/or abscesses. Of those who died, four had colon injuries and two had duodenal injuries, one of whom had combined colon and duodenal injuries. Patients with colon injuries also had a higher incidence of intra-abdominal abscesses and fistulas. Indeed, colon injury currently may be the most significant factor causing morbidity and mortality in cases of pancreatic trauma. Despite improved management of duodenal injuries, morbidity and mortality rates for these patients also remain high. Twenty-six patients went into shock before the end of their operation, and all six deaths occurred in this group. The mean number of intra-abdominal associated organ injuries was 2.1 per patient; complications and deaths were directly related to these injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A 3-year prospective study of road traffic accidents was performed in Oxfordshire by a combined team of surgeons and engineers. This liaison permitted the identification of injury sources and allowed the accurate comparison of injuries with collision severity. This was measured using the velocity change of the occupant's vehicle during the impact and was calculated using the CRASH 2 computer programme.It was shown that the pattern of chest injury varied with the direction of impact and the severity was related to the velocity change. Seatbelt use resulted in a reduction in injury severity and also modified the pattern of injuries sustained.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A consecutive series of 65 fractures, dislocations, and ligament tears produced by roller skating accidents treated by the Orthopaedic Department of the Mt. Sinai Services at City Hospital Center of Elmhurst, New York, is reviewed. It was learned that the injuries resulting from collisions occurring in a skating rink were more serious than those resulting from street accidents. Data indicated that lack of expertise is a prominent factor in the production of serious injury. However, the sport has inherent risk which is not eliminated by expertise.It was concluded that roller skating can and does produce disabling injuries. In order to reduce the number of injuries it will be required to reduce crowding in rinks, designate separate beginners' areas, use training wheels or clampon-type of skates when learning, encourage lessons, and separate beginners in the rinks.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Twenty-two patients underwent surgical stabilization of thoracic and lumbar spine fractures. Twenty patients were operated on within 4 weeks of the injury and two patients more than 1 year following injury. Harrington rods were used in 21 and Dwyer instrumentation in one. The presenting neurological deficits were: four complete, five incomplete, and 13 intact. Clinical failure was noted in four patients, two of whom underwent posterior instrumentation more than 1 year following the initial injury. The most important contributing factor to failure was use of instrumentation in deviation from standard practice.The aim of operative treatment to maintain fracture reduction, decompress neural elements, promote fracture healing, and shorten hospitalization was achieved.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

During a 101/2year interval ending in June 1980, 47 patients with penetrating cardiac trauma were managed at The University of Alabama Medical Center. Thirty-nine patients (83%) were male. Mean age was 31 years (range, 13 to 69). Thirty-two patients (68%) sustained stab wounds (SW) and 15 patients (32%) gunshot wounds (GSW). Forty-two patients (89%) arrived hypotensive (systolic blood pressure less than 90 mm Hg). Twenty-seven patients (57%) had evidence of cardiac tamponade (central venous pressure greater than 15 cm H2O) and 25 of these 27 patients were also in shock. Forty patients (85%) presented with a normal sinus rhythm and seven patients (15%) had an idioventricular rhythm or asystole.Overall mortality was 23% (11 of 47 patients). Forty-three per cent of the patients sustaining GSW (6/14) died compared to 17% (5/33) of the patients with SW (p= 0.04). Mortality for the patients in shock was 26% and for those with cardiac tamponade 15%. Mortality was 16% for the patients with both shock and cardiac tamponade. Thirteen per cent of the patients in normal sinus rhythm died, while 87% of the patients with idioventricular rhythm or asystole died (p< 0.0001).Mortality in penetrating cardiac trauma remains high, particularly in patients with GSW and in those patients presenting with an idioventricular rhythm or asystole.

ISSN:0022-5282    

出版商:OVID    

年代:1984

数据来源: OVID