ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The effects of albumin supplementation on pulmonary function were studied in 94 injured patients of whom 46 received albumin. The 94 patients received an average of 14.5 transfusions, 9.2 L crystalloid, and 0.9 L plasma in the emergency room and operating room; 46 patients received an average of 31 gm albumin during operation and 150 gm/day for 5 days. Blood pressure (BP), pulse, CVP, wedge pressure (PWP), red cell (RBCV), and plasma volumes (PV), total serum proteins (TSP), serum albumin (SA), cardiac output (CO), the per cent inspired oxygen/arterial O2tension (FIO2/pO2), and the per cent of physiologic shunting in the lungs (p shunt) were noted serially following operation; only the first study on each patient was used for statistical correlations between the two groups.Albumin supplementation significantly (p=2/ pO2ratio and the p shunt were significantly deranged in albumin patients. The FIO2/pO2ratio averaged 0.62 ± 0.6 in the albumin patients, and 0.33 ± 0.1 in the nonalbumin-treated patients; the p shunt averaged 29 and 19%, respectively. The albumin patients required ventilatory support for an average of 7.7 days versus 2.9 days in the nonalbumin patients (p=

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

To determine the effects of infusion of large volumes of crystalloid, a series of dogs was subjected to intravenous injection of oleic acid and moderate hypovolemic shock for 1 hour. They were then resuscitated with 50 cc/kg of Ringer's lactate in 30 minutes followed by blood replacement, and another 50 cc/kg of Ringer's lactate over 1 hour in one group and 2 hours in the other. Eight of nine receiving the fast infusion died during the first 2 days, and seven of eight receiving the slow infusion lived for the full 3 days of the study. The dogs that died all had large intrapulmonary shunts and gross pulmonary edema at autopsy. Both groups received the same total amount of fluid. No differences in vascular pressure or cardiac function large enough to explain the differences were found. The critical difference was the rate of fluid infusion. The high-permeability pulmonary edema appears to have been aggravated by a transitent pulmonary overperfusion induced by fast infusion of fluid.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Five examples of subdural air under tension after surgical evacuation of chronic subdural hematoma are presented. This complication can account for lack of improvement or worsening. The diagnosis is easily made with skull X-rays or computed tomography. A simple treatment using a percutaneous catheter connected to negative pressure is suggested.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Previous studies in stressed animals have shown a subjective decrease in shock-related gastric submucosal edema formation associated with the administration of H2-receptor antagonist cimetidine. The object of this study was to quantify the difference as well as to examine indices which could lead to an understanding of H2-receptor control. Fasted, stressed rats pretreated with cimetidine had significantly less edema formation than the control rats in all areas of the gastrointestinal tract, with the greatest difference seen in the stomach. Addition of intragastric hydrochloric acid did not alter cimetidine's edema-lowering capacity in the stomach. Analysis of multiple serum samples consistently showed that a stress-related decrease in vascular volume occurred, as evidenced by significant increases in hematocrit and BUN. Although cimetidine was not associated with changes in vascular volume, there was a significant (10%) increase in serum albumin in both stressed and nonstressed animals that received the drug. These data suggest an additional mechanism by which cimetidine may protect against gastric mucosal injury.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

ADH has been implicated in the development of a positive water balance in thermal injury. However, the association of plasma ADH levels to the hemodynamic response and water and electrolyte balance of early thermal injury has not been defined. Plasma ADH was measured by radioimmunoassay in 13 patients with greater than 15% body surface area burns. In three patients frequent hemodynamic measurements were also made. Large individual variations of ADH were noted, but in general the ADH levels peaked early in the postburn period and declined thereafter. The highest mean ADH value was on day 2 (53.8 = 27 pg/ml); the lowest value on day 7 (13.4 ± 8 pg/ml). Urine electrolytes demonstrated wide variation (Na+, 2 to 236 mEq/L; K+, 2 to 228 mEq/L) as did serum (261–331 mOsm/kg) and urine (557–785 mOsm/kg) osmolalities. No correlation was noted between ADH levels and osmolalities or hemodynamic variables. These data suggest that ADH response following burns is a stress response producing levels beyond the physiologic range for an antidiuretic effect and that the osmolar, hypovolemic, and hypotensive feedback loops are not involved: ADH seems to act as a vasoconstrictor and to have no significant effect on quality or quantity of urine. We conclude that the positive water balance following burns is not ADH mediated.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Mobilization of an intact omental pedicle graft for supportive use has been carried out in a variety of genitourinary reconstructive procedures. Mobilization is accomplished by detachment of the omentum from the transverse colon and by separation from the greater curvature of the stomach. The right gastroepiploic artery is generally preserved as the blood supply to the omental pedicle. Further pedicle lengthening can be achieved as necessary by selective division of the omentum, based on the arterial anatomy. The rich vascular and lymphatic supply of the omentum and its attendant potential to contribute to healing, even in the presence of infection, while maintaining its suppleness and allowing epithelization to occur over its surface, makes the omental pedicle graft an extremely useful adjunct in the following difficult situations: complicated vesicovaginal, prostatorectal, and rectovaginal fistulas; reconstruction of the bladder neck and bulbo-membranous urethral areas; extensive injury to the bladder; and a variety of renal and ureteral reconstructive procedures.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The results of the selective management of 300 abdominal stab wound victims have been reviewed for a 5-year period. Initially the need for laparotomy was evaluated by sinography, later physical examination, and most recently by local wound exploration combined with peritoneal lavage. The use of sinography resulted in an unnecessary laparotomy rate of 38%. Exploration based upon physical findings eventuated in 36% unnecessary laparotomies, of which 79% were negative, 17% morbidity, and no mortality. Local wound exploration followed by peritoneal lavage when peritoneal violation was suspected resulted in 8% unnecessary laparotomies of which half were negative, 9% morbidity, and no mortality. Based on this experience we have adopted the following approach to abdominal stab wounds. Patients with unexplained blood loss or overt signs of visceral injury undergo prompt exploration. In all other cases, peritoneal integrity is determined by local wound exploration. Patients with intact peritoneum are discharged from the Emergency Department. If peritoneal violation is evident peritoneal lavage is performed. If the lavage is positive laparotomy is undertaken, and if negative the patient is hospitalized for an additional 24 hours of observation.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

In a review of 22 patients with unstable fractures or fracture-dislocations of the thoracolumbar spine, treated by Harrington rod instrumentation and spinal arthrodesis, all arthrodeses became solid. All patients with incomplete neurologic lesions regained some function. No patient was made neurologically worse by the procedure. Solid arthrodesis was achieved whether laminectomy was performed or not. Harrington rods offer a method of reduction of compression fractures, offer partial stability to the spine, and serve as an adjunct to spine arthrodesis.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Twenty-three patients with total complete brachial plexus injuries were reviewed an average of 5.5 years from the time of injury. Three different treatment approaches were used; no surgery (four), above-elbow amputation alone (14), and shoulder arthrodesis combined with above-elbow amputation (five). Return to gainful employment and prosthetic wearing habits were best achieved with early (within the first year) above-elbow amputation alone. There seemed little to recommend arthrodesis of the shoulder combined with above elbow amputation.

ISSN:0022-5282    

出版商:OVID    

年代:1980

数据来源: OVID