摘要:

Injuries of the diaphragm in 86 patients occurring over a 10-year period were retrospectively reviewed. Blunt trauma victims experienced injury on the right and left with nearly equal frequency, representing a strikingly different experience from those reporting before. 1970 when left-sided injuries predominated.Patients' complaints and physical findings were not reliable indicators of diaphragm injury, but were usually manifestations of associated injury. Ninety-five per cent of our acute victims had other injuries. Routine chest X-rays were the most reliable diagnostic tools, yet these were normal in 1/4 of the patients. Diagnosis depends on high index of suspicion before operation and careful inspection of the diaphragm at operation. Initial thoractomy required subsequent laparotomy to complete management in seven of 15, whereas laparotomy required supplemental thoractomy only once in 65 instances. The superior operative approach, therefore, for either right or left diaphragmatic injury is initial laparotomy.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Greater civilian use of firearms and improved transportation and resuscitation of the injured have provided our institutions with an increasing experience with subclavian vascular injuries. Ninety-three patients with subclavian vascular injuries are presented and two time periods are compared. Principles of management gained from the earlier experience have been utilized with a decline in mortality to 4.7% among the patients admitted with a palpable pulse or blood pressure. Successful treatment as before still lies in the recognition of the severity of the injury, rapidity of preparation for operation, and adequacy of surgical exposure. Recent trends have included an increased reliance on selective arteriography when the patient is stable, extensive use of the book thoracotomy as a primary incision, preoperative and intraoperative autotransfusion, and a more frequent use of interposition grafting for vascular repair. Primary arterial repair was seldom accomplished; most patients required segmental resection with end-to-end anastomosis or interposition grafts.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The authors used microvascular free skin-muscle flaps to cover avulsion wounds in the lower leg of ten patients. There were three children and seven adults, ranging in age from 5 to 54 years. Vessels supplying gracilis (four) and tensor fascia lata (six) skin-muscle units were anastomosed to the anterior tibial (nine) and posterior tibial (one) vessels. The tensor fascia lata unit has a more constant anatomy and is preferred.Principles of management include: 1) early adequate, but conservative, debridement; 2) continuous bony stabilization; 3) preoperative arteriography; 4) anticoagulation; 5) recipient vessel identification in healthy uninjured tissue; 6) appropriate timing; 7) delayed bone grafting.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

This report reviews the experience with naso-ethmoid-orbital fractures at a major medical center. Thirty-three patients were treated between 1 October 1976 and 1 January 1979, who met our definition of naso-ethmoid-orbital fractures. The majority sustained trauma in a motor vehicle accident and 60% of the patients had associated nonfacial injuries.All patients had other facial injuries and fractures; orbital rim or floor, 94%; complex maxillary (LeForte II–III), 72%; and mandible fractures, 25%.Slightly over one half of the group of naso-ethmoid fractures were open; the remainder were closed injuries. Traumatic telecanthus was noted in 70% of the patients on initial examination. Cerebrospinal fluid rhinorrhea was evident in 40%, and frontal sinus fractures were detected in 25% of the group.Severe ocular injury with initial or subsequent loss of sight occurred in an alarming 30% of the patients. In addition, nasolacrimal duct system lacerations occurred in 20%. One patient developed a large carotid artery-cavernous sinus fistula 1 month postinjury.The severity of these injuries and the potential for deformity and dysfunction have not been properly emphasized in the past. Our experience has defined several diagnostic and therapeutic guidelines. For example, vastly improved results were obtained with an open reduction and internal fixation procedure. A multidisciplinary approach by a neurosurgeon, ophthalmologist, and plastic surgeon is mandatory.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Management of the critically ill or injured surgical patient requires the organization and integration of clinical, biochemical, and physiologic data to facilitate the continuity and consistency of physician decision-making. To study the influence of these factors on improving survival, the implementation of a system of metabolically and physiologically oriented ICU care, structured around a surgical teaching service, was monitored over 6 years. Key to the organization of patient care and resident teaching was the staged introduction into the ICU of a computer-based Clinical Assessment, Research, and Education (CARE) system. In its present configuration it permits interactive entry of clinical information, fluid intake and output data, biochemical, immunologic, and metabolic profiles, as related to the cardiorespiratory physiologic data. The patient's cardiovascular and metabolic abnormalities can then be compared over time to prototype patterns obtained from previously studied patients. From this physiologic state time-course trajectory, the physician can infer pathophysiologic mechanisms and make the appropriate therapeutic decisions. The phased implementation of the CARE principles into a teaching ICU surgical service has been associated with a reduction of noncardiac surgical mortality from 18.8 to 10.5% from 1973 through 1978. Trauma mortality was reduced from 25 to 7.5%, and in surgical patients with complications of gastrointestinal disease, mortality dropped from 19.7 to 8.3%. The probability that the reduction in noncardiac surgical ICU mortality was a Linear Logistic function of the increase in CARE cardiovascular physiologic studies was significant atp<0.00006. These data suggest that a structured, physiologically based, computer-facilitated ICU teaching service permits the focusing of physician attention on the clinical interactions of physiologic and metabolic problems in surgical patients. This results in a more rational and quality effective basis for clinical decision making: a significant probability (p= 0.00032) of saving 4.6% additional lives in all surgical patients, and up to 14.1% more lives in all trauma patients (p= 0.0017), can be anticipated.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Our experience with primary open reduction with rigid internal fixation of 50 open fractures is presented. Twenty-seven patients had associated major multiple trauma. Twenty fractures were articular and 26 involved 3rd-degree wounds. The infection rate was 4%. A system of staged sequential debridement and wound management is presented. The authors believe this system has contributed to the low infection rate. No secondary amputations occurred. Eighty-two per cent of the patients had good functional results using Charnley's criteria. Fatal post-traumatic cardiopulmonary failure did not occur. The authors feel that early definitive fracture care employing rigid fixation which avoids casts, and allows improved wound management and early mobilization of the multiple-trauma patient, has decreased the cardiopulmonary and metabolic consequences commonly associated with polytrauma patient care.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Six cases of microvascular free flap, composite tissue transfer are presented The advantages of utilizing this modality of tissue coverage are that it is a direct one-stage procedure which, in experienced hands and using a two-team approach, can solve complex reconstructive problems with a minimal hospital stay and minimal morbidity.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Permanent diabetes insipidus following head trauma is uncommon, but potentially fatal. The neurologic, roentgenographic, and endocrinologic findings in ten patients with this condition are reported. Eight of the patients were males under the age of 35 years. Unconsciousness (nine) and skull fracture (seven) were frequent findings. Cranial nerve damage (four) and anterior pituitary hormone deficiency requiring replacement (one) were less frequent. An automobile accident caused the trauma in six patients. Standard water deprivation tests revealed that five of the patients had total deficiency of antidiuretic hormone (ADH), and the other five had partial deficiency. The diagnosis of diabetes insipidus was markedly simplified by using a new screening test based on comparing urine and plasma osmolality in candidates with those of normal subjects.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Analysis of 57 traumatic dislocations of the hip, excluding central dislocations, is reported. No anterior dislocations occurred. Road accidents caused most of the dislocations and several patients, most of them young men, had additional serious injuries. Grading the dislocations according to Stewart and Milford (15) is useful for the prognosis, and should to a greater extent be used as a therapeutic guide. Post-traumatic osteoarthritis of the hip (7) and avascular necrosis of the head of femur were seen in 9.1 and 5.5% of the patients, respectively. The clinical results were excellent for 83.6% of the patients, and none had poor results.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID