摘要:

Seventy-six patients with synovial pseudarthrosis were reviewed. This is a distinct pathologic entity which is a different form of nonunion. The humerus, femur, and tibia were the bones most commonly involved. Routine roentgenograms were not beneficial but99mTe scans were useful for identifying this entity in 93% of rases. Light and electron microscopy revealed normal synovial lining tissue. Motion and infection may lead to the development of this condition. The results of treatment were a 43% success rate in infected cases and 59% for noninfected cases, which is far different from that of regular nonunion.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Renal function studies were performed in 275 severely injured patients with hemorrhagic shock and mastsive transfusion. There were 230 patients without renal injury and 45 patients with renal injury treated without exploration of the kidney in 17 patients, with exploration and renorrhaphy in nine patients, and with partial or total nephrectomy in 19 patients. In addition, 45 patients without renal injury were randomly matched by computer to the 45 patients with renal injury based on the number of blood transfusions and severity of shock as indicators of physiologic insult.Renal function was adversely affected by partial or total nephrectomy in patients with renal injury. Significant decreases in renal filtration and exerction were seen when the nephrectomy group was compared to the patients without renal injury matched for injury insult. Creatinine clearance decreased from 103 ml/min to 55 ml/min, inulin clearance from 106 ml/min to 63 ml/min, and osmolar clearance from 4.8 ml/min to 3.3 ml/min. The 230 patients without renal injury had an incidence of renal failure of 7.4% and a mortality rate of 8.2% compared to 11.4% and 15.6%, respectively, in the 45 patients with renal injury. Death and renal failure occurred in 13 of the 230 patients without renal injury (5.6%) and in two of the 45 renal injury patients (4.4%). The incidence of renal failure in the 19 patients without renal injury who died was 68% versus 29% in the seven renal injury patients who died. Preservation of renal parenchyma is recommended to provide maximal renal function in severely injured patients.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The treatment of facial trauma currently falls within the purview of several surgical subspecialities, including plastic surgery, oral and maxillofacial surgery, otolaryngology, ophthalmology, and neurosurgery. The complexity of facial anatomy and the newer techniques for skeletal and soft-tissue reconstruction demand interdisciplinary, rather than multidisciplinary, care for these injuries. Interdisciplinary cooperation benefits the patient with a complex facial fracture by: 1) minimizing chances for inadequate primary therapy, 2) promoting discussion of controversial therapy, and 3) providing the optimal therapy. Examples are given of unfavorable results following treatment of facial fractures. Recommendations are made to foster communication between the concerned surgical subspecialities.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

This study group comprises 73 patients who underwent emergency room resuscitative thoracotomy for cardiac arrest following penetrating chest and neck injuries. Overall, 12 patients (16.4%) were successfully resuscitated but only five (6.8%) left the hospital alive without neurologic defects. None of the 18 cases with no vital signs at all (no cardiac activity, no respiratory efforts, nonreactive pupils) on admission survived. Only one out of the 19 cases with no cardiac activity and with fixed pupils but present respiratory efforts survived (5.3%). Of 14 patients with cardiac arrest but with respiratory efforts and reactive pupils, three survived (21.4%). We suggest that patients with no vital signs on admission to the hospital should not be subjected to resuscitative thoracotomy.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Sixty-three consecutive patients presented during an 18-month period with isolated closed fractures of the fifth metacarpal neck. Follow-up ranged from 3 to 20 months. Forty were recalled for study and divided into a conservative group (25 patients) and an operative group (15 patients). Both groups were statistically comparable. All patients obtained good results. Subjectively, no patient had long-term pain or dissatisfaction with the functional or cosmetic result. Objectively, all patients regained full joint motion and normal grip strength. Mild rotatory malalignment was present in both groups, but the conservative group had less extensor lag. The main difference between the two groups centered on residual dorsal angulation. This cosmetic deformity was considerably less in the operative group, although the cost of this improvement was significantly longer rehabilitation. Failure to correct dorsal angulation was not associated with functional disability.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Reduction of stable (Evans I and II) trochanteric fractures of the hip is in general a simple procedure.Using a low (145°–150°) nail-plate fixation (McLaughlin) for this type of fracture, early weight-bearing ambulation can be obtained.In the period from 1 January 1978 through 1 May 1982 52 stable trochanteric fractures in 52 patients were treated by low nail-plate fixation. Within 1 week postoperatively, the patients started full weight-bearing ambulation. The functional result was good in 88.2%. Despite the average age of 77.9 years the hospital mortality rate was 1.9%.On the basis of the results mentioned above, it is concluded that the described treatment of stable trochanteric fractures can be considered reliable.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The radiographs of all patients admitted to the Naval Hospital, Oakland with the diagnosis of pelvic trauma from 1981 through 1985 were reviewed. Thirty-one patients sustained single or double vertical ring fractures. Fifteen of these patients underwent both plain radiography and Computerized Axial Tomographic (CAT) scans in the evaluation of their pelvic injuries. The CAT scans of these pelvic injuries aided in detecting occult sacroiliac disruptions, determining the extent of posterior ring comminution, evaluating possible extension of the pelvic fractures into the acetabulum, assessing pelvic ring stability, and demonstrating soft-tissue injuries within the pelvis.Six pelvic injuries were diagnosed as single vertical breaks in the pelvic ring and nine were diagnosed as double vertical breaks in the pelvic ring by plain radiographs. CAT scanning demonstrated occult posterior ring disruptions in four patients which led to the reclassification of their injuries to double vertical fractures. CAT scanning also demonstrated significant degrees of sacral comminution in five patients which altered surgical treatment plans in all five patients. Two fractures were classified as unstable based on marked sacral comminution demonstrated on CAT scan. Extension of the pelvic ring fractures into the acetabulum was suggested on plain radiographs in three patients and was excluded by review of the CAT scans in these patients. Significant intrapelvic hematomas were demonstrated in three patients and urine extravasation into the hip joint from a bladder laceration was seen in one patient with the CAT scan.We concluded that the indications for CAT scanning of pelvic fractures are: 1) single breaks in the pelvic ring in which a significant posterior ring injury is suspected but cannot be confirmed by plain radiography; 2) double vertical fractures of the pelvis in which plain radiographs or physical examination cannot conclusively demonstrate the stability of the pelvis; 3) evaluation of fracture pattern extension into the articular portion of the acetabulum; 4) injuries to the pelvis that are under consideration for open reduction and internal fixation; and 5) evaluation of intrapelvic soft-tissue injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A 30% body surface area, open-flame, full-thickness burn of adult rats induced a 4-day period of anorexia that was followed by hyperphagia beginning on postburn day 10. The hyperphagic burned rats also exhibited increased resting energy expenditure and no gain in body weight, suggesting hypermetabolism. Plasma levels of immunoreactive insulin and albumin were decreased in both groups of burned rats; immunoreactive pancreatic glucagon concentrations were elevated only in the anorectic burned rats. Plasma levels of epinephrine were elevated in the hyperphagic burned rats. In the brain, dopamine metabolism appeared to be increased in the corpus striatum, nucleus accumbens, and amygdala of anorectic burned rats; norepinephrine levels were elevated in the hypothalamus and nucleus accumbens of the hyperphagic-hypermetabolic rats. These data indicate that this animal model of major burn trauma exhibits anorexia, hyperphagia, catabolism, and hypermetabolism. Furthermore, elevated dopamine metabolism appears to be associated with the anorexia, while the hyperphagia-hypermetabolism may be mediated by norepinephrine.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The synthetic immunomodulators muramyl dipeptide (MDP), thymopoietin pentapeptide (TP5), and CP-46,665 were examined for their effects on wound healing in mice. We found no differences in wound disruption strength between immunomodulator-treated animals and saline controls on days 11, 14, and 21. The only exception was with high-dose CP-46,665, which produced weakened wounds on day 14 (p< 0.05) and 21 (p< 0.01). CP-46,665 was further studied by injecting high and low doses 48 hours before or after wounding. No differences were seen for these groups compared to controls at 11 and 21 days. Finally, to simulate a common clinical situation, mice were subjected to a 10% total body surface area (TBSA) burn to the right paraspinal region. Twenty-four hours later, a left paraspinal incision was performed with simultaneous injection of saline,Corynebacterium parvum(C. parvum), or low-dose TP-5, MDP, or CP-46,665. At 11 days, no detriment in wound healing was found for burned control or any of the immunomodulator-treated animals except in theC. parvum-treated mice, with significantly weakened skin strips (p< 0.001). WhileC. parvummay be detrimental to wound healing, the synthetic modulators tested appear to have little effect on wound healing.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The charts of 127 consecutive patients who sustained renal trauma between December 1977 and January 1984 were reviewed in order to relate the results of intravenous pyelogram (IVP) to the magnitude of renal pathology. Eightyeight cases resulted from blunt trauma and 39 cases had penetrating injuries. There were 34 gunshot wounds and five stab wounds. An IVP was performed in 116 patients. All cases of blunt trauma with an IVP reported as normal had no renal pathology greater than contusion. Intravenous pyelogram results in penetrating injuries had a 75% false negative rate. Findings of nonvisualization or extravasation were significant for fractures, perforation, or pedicle injuries in all trauma.Eight of the patients with nonpenetrating wounds and 37 of the patients with penetrating injury underwent exploratory laparotomy. Sixteen mephrectomies were performed for a nephrectomy rate of 12.6% of the total series. This nephrectomy rate is comparable to similar studies which are reviewed.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID